| NPI | 1245078013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEDRA JOHNSON Owner 716-444-2537 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2024-11-26 |