Provider Demographics
NPI:1578796181
Name:GANRORMIC
Entity Type:Organization
Organization Name:GANRORMIC
Other - Org Name:WEE CAN PRESCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WETTLAUFER
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:716-667-2294
Mailing Address - Street 1:26 PAWTUCKET ROW
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3920
Mailing Address - Country:US
Mailing Address - Phone:716-662-7456
Mailing Address - Fax:716-667-2272
Practice Address - Street 1:40 CENTRE DR
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-4100
Practice Address - Country:US
Practice Address - Phone:716-667-2294
Practice Address - Fax:716-667-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-29
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353200163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY21122OtherNYS DEPARTMENT OF HEALTH