Provider Demographics
NPI:1053342535
Name:OESTERLE, SUSAN A (RN,MSN,FNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:A
Last Name:OESTERLE
Suffix:
Gender:F
Credentials:RN,MSN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14206-1964
Mailing Address - Country:US
Mailing Address - Phone:716-893-1010
Mailing Address - Fax:716-893-1002
Practice Address - Street 1:1560 HARLEM RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14206-1964
Practice Address - Country:US
Practice Address - Phone:716-893-1010
Practice Address - Fax:716-893-1002
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332128-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF332128-1OtherLICENSE
NY02022168Medicaid
DD5588Medicare ID - Type Unspecified
NY02022168Medicaid
NYRB4776Medicare PIN
NYS94875Medicare UPIN