Provider Demographics
NPI:1730123696
Name:BIERSBACH, NICOLE MARIE (RPA C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:BIERSBACH
Suffix:
Gender:F
Credentials:RPA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1236
Mailing Address - Country:US
Mailing Address - Phone:716-712-0490
Mailing Address - Fax:716-712-0615
Practice Address - Street 1:3075 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1236
Practice Address - Country:US
Practice Address - Phone:716-712-0490
Practice Address - Fax:716-712-0615
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0089201363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P90031Medicare UPIN
DD5777Medicare ID - Type Unspecified