Individual
KELLY A MAROTTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1150 YOUNGS RD STE 202, WILLIAMSVILLE, NY 14221-8024
(716) 636-9004
Mailing address
PO BOX 488, BUFFALO, NY 14240-0488
(668) 539-5518
(203) 916-1041
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
521501
NY
363L00000X
Nurse Practitioner
Primary
335120
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02869432
—
NY
Enumeration date
01/30/2007
Last updated
08/13/2020
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