Provider Demographics
NPI:1407040280
Name:OCCUPATIONAL HEALTH SERVICES RPN NP ADULT HEALTH PLLC
Entity Type:Organization
Organization Name:OCCUPATIONAL HEALTH SERVICES RPN NP ADULT HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:716-945-2825
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:187-189 CENTER STREET
Mailing Address - City:SALAMANCA
Mailing Address - State:NY
Mailing Address - Zip Code:14779-0375
Mailing Address - Country:US
Mailing Address - Phone:716-945-2825
Mailing Address - Fax:716-945-2827
Practice Address - Street 1:187-189 CENTER STREET
Practice Address - Street 2:
Practice Address - City:SALAMANCA
Practice Address - State:NY
Practice Address - Zip Code:14779-1454
Practice Address - Country:US
Practice Address - Phone:716-945-2825
Practice Address - Fax:716-945-2827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303946 1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty