# ILLUMINATE NP PSYCHIATRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003671009
- **Authorized official:** AMY KOTARSKI DNP (OWNER/PSYCHIATRIC NURSE PRACTITIONE)
- **Authorized official phone:** (716) 903-6036

## Contact information

- **Practice address:** 3055 SOUTHWESTERN BLVD STE 110, ORCHARD PARK, NY 14127-1231
- **Practice address phone:** (716) 903-6036
- **Mailing address:** 3055 SOUTHWESTERN BLVD STE 110, ORCHARD PARK, NY 14127-1231

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/19/2024
- **Last updated:** 02/19/2024