Provider Demographics
NPI:1598732414
Name:OLDENBURG, MOLLI MEGAN (NP)
Entity Type:Individual
Prefix:
First Name:MOLLI
Middle Name:MEGAN
Last Name:OLDENBURG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MOLLI
Other - Middle Name:MEGAN
Other - Last Name:WARUNEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:ELM AND CARLTON STREETS
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14263-0001
Mailing Address - Country:US
Mailing Address - Phone:716-845-2300
Mailing Address - Fax:716-845-3423
Practice Address - Street 1:ELM AND CARLTON STREETS
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14263
Practice Address - Country:US
Practice Address - Phone:716-845-2300
Practice Address - Fax:716-845-3423
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334348363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000560906002OtherBLUE CROSS
00027033301OtherUNIVERA
NY02603327Medicaid
156048BFOtherPREFERRED CARE
NY000560906001OtherBLUE CROSS
9512748OtherINDEPENDENT HEALTH
156048BFOtherPREFERRED CARE