Provider Demographics
NPI:1588686307
Name:OSSWALD, JOAN M (NP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:OSSWALD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 UNION RD
Mailing Address - Street 2:SUTIE 21
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1470
Mailing Address - Country:US
Mailing Address - Phone:716-706-2034
Mailing Address - Fax:716-706-2035
Practice Address - Street 1:397 LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14204-2275
Practice Address - Country:US
Practice Address - Phone:716-847-6610
Practice Address - Fax:716-854-3052
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330889363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9511996OtherINDEPENDENT HEALTH
NY040426001225OtherFIDELIS
NY000560100001OtherBLUE CROSS OF WNY
NY00026547501OtherUNIVERA
NY500018942OtherRAILROAD MEDICARE
NY500018942OtherRAILROAD MEDICARE
NY00026547501OtherUNIVERA