Provider Demographics
NPI:1124115779
Name:SHATZEL, RUTH ALICE (PNP)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ALICE
Last Name:SHATZEL
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2281 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:NY
Mailing Address - Zip Code:14085-9646
Mailing Address - Country:US
Mailing Address - Phone:716-627-4853
Mailing Address - Fax:
Practice Address - Street 1:3705 SENECA ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3452
Practice Address - Country:US
Practice Address - Phone:716-674-2404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY380250363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics