Provider Demographics
NPI:1902578313
Name:VERRALL, JORDAN RAE (FNP)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:RAE
Last Name:VERRALL
Suffix:
Gender:
Credentials:FNP
Other - Prefix:MISS
Other - First Name:JORDAN
Other - Middle Name:RAE
Other - Last Name:ARTIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:726 EXCHANGE ST STE 710
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14210-1464
Mailing Address - Country:US
Mailing Address - Phone:716-852-4772
Mailing Address - Fax:
Practice Address - Street 1:111 N MAPLEMERE RD STE 200
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3182
Practice Address - Country:US
Practice Address - Phone:716-626-2644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347799363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner