Provider Demographics
NPI:1235145905
Name:HART, VIRGINIA M (NURSE PRACITIONER)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:M
Last Name:HART
Suffix:
Gender:F
Credentials:NURSE PRACITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:85 HIGH ST
Practice Address - Street 2:
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:716-859-3555
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004180-1363A00000X
NYF300536-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9512109OtherIHA
NYP00142393OtherRR MEDICARE
NY161000580OtherNOVA
NY000560263005OtherHEALTH NOW
NY00026516503OtherUNIVERA
NY01873156Medicaid
NYR56803Medicare UPIN
NY01873156Medicaid