Individual
LISA WALLENFELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1360 N FOREST RD, STE 102, WILLIAMSVILLE, NY 14221-1200
(716) 639-4034
(716) 639-7814
Mailing address
2240 NORTH FOREST RD., WILLIAMSVILLE, NY 14221
(716) 639-4034
(716) 639-7814
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
420426
NY
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
F420426
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000560362003
BCBS
NY
01
—
9512212
IHA
NY
Enumeration date
02/19/2007
Last updated
09/27/2019
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