Provider Demographics
NPI:1598713547
Name:WIERTEL, ANN L (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:L
Last Name:WIERTEL
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 1:160 LITTLE ROBIN RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1123
Mailing Address - Country:US
Mailing Address - Phone:716-688-0931
Mailing Address - Fax:716-862-8640
Practice Address - Street 1:3495 BAILEY AVE 512D
Practice Address - Street 2:VA WESTERN NY HEALTHCARE SYSTEM
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215
Practice Address - Country:US
Practice Address - Phone:716-862-6506
Practice Address - Fax:716-862-8640
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-332481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02119831Medicaid
NY02119831Medicaid