Individual
MRS. JACQUELYN ANNE BOTTICELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
60 INNSBRUCK DR, BUFFALO, NY 14227-2735
(716) 668-7051
(716) 669-7069
Mailing address
3332 WALDEN AVE., SUITE 110, DEPEW, NY 14043
(716) 668-7051
(716) 669-7069
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
30-304311
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03061112
—
NY
01
—
9515444
INDEPENDENT HEALTH
NY
Enumeration date
07/11/2005
Last updated
03/11/2009
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