Provider Demographics
NPI:1578852786
Name:BIERBRAUER, MARY D (RN)
Entity Type:Individual
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First Name:MARY
Middle Name:D
Last Name:BIERBRAUER
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Gender:F
Credentials:RN
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Mailing Address - Street 1:77 GOODELL ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1243
Mailing Address - Country:US
Mailing Address - Phone:716-816-7200
Mailing Address - Fax:716-852-0760
Practice Address - Street 1:3980 SHERIDAN DR
Practice Address - Street 2:6TH FL
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1727
Practice Address - Country:US
Practice Address - Phone:716-882-6544
Practice Address - Fax:716-882-6833
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-11-18
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Provider Licenses
StateLicense IDTaxonomies
NY415468-1163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1578852786OtherBLUE CROSS
NY6516597OtherINDEPENDENT HEALTH
NY03338869Medicaid