Provider Demographics
NPI:1619998374
Name:DECHERT-BOSS, BETSEY (NP)
Entity Type:Individual
Prefix:
First Name:BETSEY
Middle Name:
Last Name:DECHERT-BOSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BETSEY
Other - Middle Name:
Other - Last Name:DECHERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3675 SOUTHWESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1732
Mailing Address - Country:US
Mailing Address - Phone:716-972-0279
Mailing Address - Fax:716-972-0273
Practice Address - Street 1:3675 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1732
Practice Address - Country:US
Practice Address - Phone:716-972-0279
Practice Address - Fax:716-972-0273
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330430363LF0000X
NY389449163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000560340005OtherBCBS WNY
NY000560340007OtherBC/BS DIAB. ED. SERV.
NY9513178OtherINDEPENDENT HEALTH
NY02345682Medicaid
NY00021052102OtherUNIVERA
NYP00356733OtherMEDICARE RAILROAD
NY000560340006OtherBCBS
NY177087BJOtherPREFERRED CARE
NY00021052102OtherUNIVERA
NY02345682Medicaid
RA0702Medicare PIN