Provider Demographics
NPI:1083970529
Name:SPETA, KATHLEEN (FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SPETA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1947
Mailing Address - Country:US
Mailing Address - Phone:716-677-4159
Mailing Address - Fax:716-677-4470
Practice Address - Street 1:15 LODER ST
Practice Address - Street 2:191 NORTH MAIN STREET
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1112
Practice Address - Country:US
Practice Address - Phone:585-596-4129
Practice Address - Fax:585-596-0653
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3370711163WG0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice