Provider Demographics
NPI:1881164853
Name:AVP PRIMARY CARE ADULT HEALTH NURSE PRACTITIONER, PLLC
Entity type:Organization
Organization Name:AVP PRIMARY CARE ADULT HEALTH NURSE PRACTITIONER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIOUDMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLISS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MS, ANP-C
Authorized Official - Phone:716-706-8984
Mailing Address - Street 1:94 CORIANDER CT
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1265
Mailing Address - Country:US
Mailing Address - Phone:716-706-8984
Mailing Address - Fax:
Practice Address - Street 1:6631 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5934
Practice Address - Country:US
Practice Address - Phone:716-706-8984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty