Provider Demographics
NPI:1558072140
Name:JANESE, AMY BETH
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:JANESE
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 1:3927 LOCKPORT RD
Mailing Address - Street 2:
Mailing Address - City:SANBORN
Mailing Address - State:NY
Mailing Address - Zip Code:14132-9407
Mailing Address - Country:US
Mailing Address - Phone:716-998-8537
Mailing Address - Fax:
Practice Address - Street 1:4403 E LAKE RD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NY
Practice Address - Zip Code:14172-9641
Practice Address - Country:US
Practice Address - Phone:716-751-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider