Etta L Storm, NP IN PEDIATRICS

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

F380276-1 Issued in NY

Practice address

3085 Southwestern Blvd
Suite 104
Orchard Park, NY 14127-1233

Phone

(716) 674-1292

Fax

(716) 677-4314

NPI assigned

Aug 29, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487762258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3085 SOUTHWESTERN BLVD",
            "address_2": "SUITE 104",
            "city": "ORCHARD PARK",
            "state": "NY",
            "postal_code": "141271233",
            "telephone_number": "716-674-1292",
            "fax_number": "716-677-4314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3085 SOUTHWESTERN BLVD",
            "address_2": "SUITE 104",
            "city": "ORCHARD PARK",
            "state": "NY",
            "postal_code": "141271233",
            "telephone_number": "716-674-1292",
            "fax_number": "716-677-4314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STORM",
        "first_name": "ETTA",
        "middle_name": "L",
        "credential": "NP IN PEDIATRICS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "F380276-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT HEALTH",
            "identifier": "9511811",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA HEALTHCARE",
            "identifier": "00026500201",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF WESTERN NEW YORK",
            "identifier": "000560930001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda Marie Stockmeyer, P.N.P
• Julia Marie Stoerr, PA-C
• Alyssa Stoltman
• Tracie L Stoos
• Donald F Storm, MD
• Mitchell Derrick Streety
• Tara Marie Struebel, N.P.
• David Thomas Styn, O.D.
• Elizabeth Suchan, M.S.
• Lori Sullivan

• Pediatric Nurse Practitioner in Orchard Park, NY
• Providers in Orchard Park, NY by specialty
• Pediatric Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.