Provider Demographics
NPI:1407954480
Name:HAMBRIDGE, JOANNE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:HAMBRIDGE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2501
Mailing Address - Country:US
Mailing Address - Phone:716-773-2494
Mailing Address - Fax:
Practice Address - Street 1:1750 PINE AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-2232
Practice Address - Country:US
Practice Address - Phone:716-215-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333727363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000560735002OtherBLUES
NY00026920402OtherUNIVERA
NY9512697OtherINDEPENDENT HEALTH
NYRA6747Medicare ID - Type Unspecified
NY000560735002OtherBLUES