Basic Information
Provider Information
NPI: 1982832325
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STAWIASZ
FirstName: KAREN
MiddleName: ANN
NamePrefix: MISS
NameSuffix:  
Credential: N.P.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2157 MAIN ST
Address2:  
City: BUFFALO
State: NY
PostalCode: 142142648
CountryCode: US
TelephoneNumber: 7168621000
FaxNumber:  
Practice Location
Address1: 2157 MAIN ST
Address2:  
City: BUFFALO
State: NY
PostalCode: 142142648
CountryCode: US
TelephoneNumber: 7168621000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/24/2009
LastUpdateDate: 06/24/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200XF301172-1NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


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