Provider Demographics
NPI:1922064393
Name:PASSMORE, NATALIE ANN (ANP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANN
Last Name:PASSMORE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 ORCHARD PARK RD
Mailing Address - Street 2:D
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1208
Mailing Address - Country:US
Mailing Address - Phone:716-671-8393
Mailing Address - Fax:716-671-8398
Practice Address - Street 1:3041 ORCHARD PARK RD
Practice Address - Street 2:D
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1208
Practice Address - Country:US
Practice Address - Phone:716-671-8393
Practice Address - Fax:716-671-8398
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3039321363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02651518Medicaid
NYJ400081844Medicare PIN
NY000560921002OtherBL UE CROSS BLUE SHIELD
NY00027037202OtherUNIVERA