Provider Demographics
NPI:1376502609
Name:BRUDO JUREK, PAULA (NP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:BRUDO JUREK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:206 S ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-2398
Mailing Address - Country:US
Mailing Address - Phone:716-847-0212
Mailing Address - Fax:716-541-0680
Practice Address - Street 1:65 LAWRENCE BELL DR STE 102
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7182
Practice Address - Country:US
Practice Address - Phone:716-276-8375
Practice Address - Fax:716-276-8381
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330893363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9512279OtherINDEPENDENT HEALTH ASSC
NY000560119003OtherBC WESTERN NY
NY000560119003OtherBC WESTERN NY
13005DMedicare ID - Type Unspecified