MAXINE KIDDER (NPI# 1124084090) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124084090 |
| Entity Type | Individual |
| Full Name | MAXINE KIDDER |
| Credential | P.N.P. |
| Practice Address |
139 Professional Pkwy Lockport NY 14094-5369 |
| Practice Telephone | 7164336711 |
| Practice Fax Number | 7164330546 |
| Mailing Telephone | 7164336711 |
| Mailing Fax Number | 7164330546 |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
380525 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | BLUE CROSS/BLUE SHIELD | 000560073003 | 01 |
| NY | 01400724 | 05 | |
| NY | INDEPENDENT HEALTH | 9512424 | 01 |
| Street Address |
139 PROFESSIONAL PKWY |
| City | LOCKPORT |
| State | NY |
| Zip Code | 14094-5369 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861979098 | Brittany Nicole Sisson | Nurse Practitioner | 139 Professional Pkwy, Lockport, NY 14094-5369 | 2018-07-20 |
| 1639699192 | Chelsea L Mckenna | Nurse Practitioner | 139 Professional Pkwy, Lockport, NY 14094-5369 | 2017-06-26 |
| 1669866125 | Kaitlyn A Wojewoda | Nurse Practitioner | 139 Professional Pkwy, Lockport, NY 14094-5369 | 2015-03-23 |
| 1407264229 | Erika Brooke Waver | Nurse Practitioner | 139 Professional Pkwy, Lockport, NY 14094-5369 | 2014-07-24 |
| 1427236330 | Vanessa E Marthia | Registered Nurse | 139 Professional Pkwy, Lockport, NY 14094 | 2008-02-01 |
| 1083820351 | William J Baier Md Pllc | Pediatrics | 139 Professional Pkwy, Lockport, NY 14094-5369 | 2007-05-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093377723 | Sarah A Shaw Od Optometrist Pllc | Optometrist | 215 East Avenue, Lockport, NY 14094 | 2019-07-02 |
| 1780168732 | Woodbridge Nurse Practitioner In Psychiatry Pllc | Clinic/Center | 680 Davison Road, Lockport, NY 14094 | 2018-09-17 |
| 1124512249 | Leleya Tsygyrlash | Registered Nurse | 6332 Green Valley Lane, Lockport, NY 14094 | 2018-06-21 |
| 1699226811 | Jessica Monroe | Specialist | 51 High Street, Lockport, NY 14094 | 2016-10-24 |
| 1689127334 | Allison Cuzzacrea | Physician Assistant | 3644 Day Road, Lockport, NY 14094 | 2016-07-29 |
| 1386027878 | Michael T Trombitas | Chiropractor | 244 Bewley Building, Market Street, Lockport, NY 14094 | 2015-07-02 |
| 1407265226 | Mary Len I | Social Worker | 519 Bewley Building, Lockport, NY 14094 | 2014-08-06 |
| 1871904441 | Edtasha New | Registered Nurse | 120 South New York Street, Lockport, NY 14094 | 2014-05-16 |
| 1326469313 | Eastern Niagara Neurology PC | Psychiatry & Neurology | 170 Professional Parkway, Lockport, NY 14094 | 2013-12-18 |
| 1720348261 | Bianca Angelica Belli | Family Medicine | 5875 S. Transit Road, Lockport, NY 14094 | 2012-05-17 |
| Find all providers in zip 14094 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639518657 | Colleen Anne Lamonte | Nurse Practitioner | 300 Read St Ste D, Lockport, IL 60441-3265 | 2013-06-24 |
| 1821054792 | Debora A Sippel | Nurse Practitioner | 139 Professional Parkway, Lockport, NY 14094 | 2006-04-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932709821 | Shu-heng Wang | Nurse Practitioner | 7324 18th Ave, Brooklyn, NY 11204-5678 | 2020-10-29 |
| 1952909012 | Marina Byshovets | Nurse Practitioner | 164 Admiralty Loop, Staten Island, NY 10309-3964 | 2020-10-12 |
| 1700483799 | Dmitry Pediatrics, Pediatric Nurse Practitioner PC | Nurse Practitioner | 10 Shore Blvd Apt 1g, Brooklyn, NY 11235-4022 | 2020-10-03 |
| 1427664572 | Leigh Ann Cohen | Nurse Practitioner | 2 Lincoln Ave Ste 301, Rockville Centre, NY 11570-5775 | 2020-09-23 |
| 1295341436 | Tatiana Margaret Masone | Nurse Practitioner | 3142 Victory Blvd, Staten Island, NY 10314-6717 | 2020-09-22 |
| 1992311567 | Jyneva W Pickel | Nurse Practitioner | 3959 Broadway Rm 722, New York, NY 10032-1559 | 2020-09-19 |
| 1902410186 | Katie Elise Boyd | Nurse Practitioner | 725 Irving Ave Ste 504, Syracuse, NY 13210-1683 | 2020-09-03 |
| 1437763877 | Tiffany Yu | Nurse Practitioner | 1746 W 12th St, Brooklyn, NY 11223-1101 | 2020-09-02 |
| 1134733710 | Khristan Heagle Haller | Nurse Practitioner | 20 Locust Ln, Bronxville, NY 10708-4933 | 2020-09-01 |
| 1831703412 | Marijana Waite | Nurse Practitioner | 6544 Saunders St Apt A7, Rego Park, NY 11374-4209 | 2020-09-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.