Provider Demographics
NPI:1417299108
Name:KLOC, LONNIE J
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:J
Last Name:KLOC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 MAPLE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2700
Mailing Address - Country:US
Mailing Address - Phone:716-276-8375
Mailing Address - Fax:716-276-8381
Practice Address - Street 1:1829 MAPLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2700
Practice Address - Country:US
Practice Address - Phone:716-276-8375
Practice Address - Fax:716-276-8381
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337615363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily