MEDICARE: SAADIQUA M WIMES LPN

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	164W00000X	Licensed Practical Nurse	337027	NY

General Provider Information

NPI Number	:	1477171379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAADIQUA M WIMES LPN

Provider Business Mailing Address
First Line	:	75 MONICA ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14619-1942
Country	:	US
Telephone Number	:	585-957-0632
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 MONICA ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14619-1942
Country	:	US
Telephone Number	:	585-957-0632
Fax Number	:

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

Provider Enumeration Date	:	07/08/2020
Last Update Date	:	07/08/2020

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