Provider Demographics
NPI:1093955726
Name:CLONTZ, KRISTA MOLISON (ANP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:MOLISON
Last Name:CLONTZ
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8235
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:85 HIGH ST
Practice Address - Street 2:BUFFALO
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1149
Practice Address - Country:US
Practice Address - Phone:716-630-1000
Practice Address - Fax:716-630-1054
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY426857363LF0000X
NY305074363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily