Individual
ETTA L STORM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP IN PEDIATRICS
Contact information
Practice address
3085 SOUTHWESTERN BLVD, SUITE 104, ORCHARD PARK, NY 14127-1233
(716) 674-1292
(716) 677-4314
Mailing address
3085 SOUTHWESTERN BLVD, SUITE 104, ORCHARD PARK, NY 14127-1233
(716) 674-1292
(716) 677-4314
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
F380276-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00026500201
UNIVERA HEALTHCARE
—
01
—
000560930001
BCBS OF WESTERN NEW YORK
—
01
—
9511811
INDEPENDENT HEALTH
—
Enumeration date
08/29/2006
Last updated
07/08/2007
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