Provider Demographics
NPI:1548577539
Name:NIEDERMAYER, CATHLEEN MARIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:MARIE
Last Name:NIEDERMAYER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-1848
Mailing Address - Country:US
Mailing Address - Phone:716-650-9760
Mailing Address - Fax:716-650-9622
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-650-9760
Practice Address - Fax:716-650-9622
Is Sole Proprietor?:No
Enumeration Date:2010-09-12
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03295416Medicaid
NYJ400045793OtherNGS MEDICARE