Provider Demographics
NPI:1124213780
Name:KORDASIEWICZ, LYNN M (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:KORDASIEWICZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:6255 SHERIDAN DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4836
Mailing Address - Country:US
Mailing Address - Phone:716-857-8666
Mailing Address - Fax:716-857-8944
Practice Address - Street 1:2355 UNION RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-2234
Practice Address - Country:US
Practice Address - Phone:716-857-8603
Practice Address - Fax:716-856-5844
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY304627363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner