Provider Demographics
NPI:1720369184
Name:ANSELMO-WITZEL, SONIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:
Last Name:ANSELMO-WITZEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 ERIE STATION RD
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9750
Mailing Address - Country:US
Mailing Address - Phone:585-359-5312
Mailing Address - Fax:585-359-5353
Practice Address - Street 1:639 ERIE STATION RD
Practice Address - Street 2:
Practice Address - City:WEST HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586-9750
Practice Address - Country:US
Practice Address - Phone:585-359-5312
Practice Address - Fax:585-359-5353
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY443721163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY166002034Medicaid