Individual
MAXINE KIDDER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
P.N.P.
Contact information
Practice address
139 PROFESSIONAL PKWY, LOCKPORT, NY 14094-5369
(716) 433-6711
(716) 433-0546
Mailing address
139 PROFESSIONAL PKWY, LOCKPORT, NY 14094-5369
(716) 433-6711
(716) 433-0546
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
380525
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000560073003
BLUE CROSS/BLUE SHIELD
NY
05
—
01400724
—
NY
01
—
9512424
INDEPENDENT HEALTH
NY
Enumeration date
04/21/2006
Last updated
07/08/2007
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