Individual
MISSY GRAY DISHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3041 ORCHARD PARK RD STE C, ORCHARD PARK, NY 14127-1238
(716) 674-3104
(716) 674-0666
Mailing address
3041 ORCHARD PARK RD STE C, ATT: CREDENTIALING, ORCHARD PARK, NY 14127-1238
(716) 674-3104
(716) 674-0666
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F309096
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05536787
—
NY
01
—
309096
NYS LICENSE
NY
Enumeration date
03/05/2019
Last updated
01/11/2023
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