Provider Demographics
NPI:1851317903
Name:MOBILE NURSE PRACTITIONERS
Entity Type:Organization
Organization Name:MOBILE NURSE PRACTITIONERS
Other - Org Name:HOMELINK MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEITH-MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:ANP,GNP
Authorized Official - Phone:716-634-2671
Mailing Address - Street 1:240 IRVINGTON DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-1412
Mailing Address - Country:US
Mailing Address - Phone:716-634-2671
Mailing Address - Fax:716-634-2673
Practice Address - Street 1:5574 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5452
Practice Address - Country:US
Practice Address - Phone:716-634-2671
Practice Address - Fax:716-634-2673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02022168Medicaid
NYF3321281OtherLICENSE
NYDD5588Medicare ID - Type Unspecified
NYP22619Medicare UPIN