Provider Demographics
NPI:1578520805
Name:WETTLAUFER, JULIE ANN (FNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:WETTLAUFER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4511 HARLEM ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3822
Mailing Address - Country:US
Mailing Address - Phone:716-839-6720
Mailing Address - Fax:716-839-6740
Practice Address - Street 1:219 BRYANT STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2006
Practice Address - Country:US
Practice Address - Phone:716-878-7109
Practice Address - Fax:716-888-3917
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330455363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000560224001OtherBC/BS
PA0014387840001Medicaid
NY01299412Medicaid
040426001131OtherFIDELIS
00027160401OtherUNIVERA
9590313OtherIHA
NY01299412Medicaid