Provider Demographics
NPI:1336939594
Name:ANSON, MAURA (AGNP)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:ANSON
Suffix:
Gender:
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 VANDERVOORT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-7246
Mailing Address - Country:US
Mailing Address - Phone:716-909-4325
Mailing Address - Fax:
Practice Address - Street 1:60 MAPLE RD STE 1
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2917
Practice Address - Country:US
Practice Address - Phone:716-626-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312206363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health