MEDICARE: CATHY JO ALLEN RN

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	390200000X	Student in an Organized Health Care Education/Training Program	524186	NY

General Provider Information

NPI Number	:	1255680013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHY JO ALLEN RN

Provider Business Mailing Address
First Line	:	281 W RIDGE RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14615-2927
Country	:	US
Telephone Number	:	585-324-5925
Fax Number	:	585-474-4463

Provider Business Practice Location Address
First Line	:	281 W RIDGE RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14615-2927
Country	:	US
Telephone Number	:	585-324-5925
Fax Number	:	585-474-4463

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

Provider Enumeration Date	:	09/07/2012
Last Update Date	:	09/07/2012

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