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Provider Information for 1609097161

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1609097161

Calendar   Last Updated:  2007-07-08
  Certification Date: 


Name Value
NPI 1609097161
Enumeration Date 2007-05-01
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 7124 COUNTY ROAD 2
BLOOMFIELD, NY 14469-9761
United States

Phone: 585-657-7896 | Fax: 315-781-3802
View Map External Link
Primary Practice Address 119 SAINT CLAIR ST
GENEVA, NY 14456-3100
United States

Phone: 315-781-3600 | Fax: 315-781-3802
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other N.P. LICENSE # NY F300074
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LA2200X - Nurse Practitioner Adult Health NY F300074