Provider Demographics
NPI:1013774363
Name:JOTNO FAMILY HEALTH NURSE PRACTITIONER PLLC
Entity Type:Organization
Organization Name:JOTNO FAMILY HEALTH NURSE PRACTITIONER PLLC
Other - Org Name:KURA PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TANVIR
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:716-204-4856
Mailing Address - Street 1:273 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14218-1222
Mailing Address - Country:US
Mailing Address - Phone:716-204-4856
Mailing Address - Fax:
Practice Address - Street 1:273 RIDGE RD STE 2
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14218-1222
Practice Address - Country:US
Practice Address - Phone:716-204-4856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty