MEDICARE: MRS. KARRAH MICHI GANTZ FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	343391	NY

General Provider Information

NPI Number	:	1033696778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARRAH MICHI GANTZ FNP

Provider Business Mailing Address
First Line	:	100 WENDOVER RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14610-2348
Country	:	US
Telephone Number	:	203-767-0721
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 WHITE SPRUCE BLVD STE B
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-1619
Country	:	US
Telephone Number	:	585-424-6490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	06/30/2023

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