MEDICARE: MRS. KRISTEN JAYNEMANZER NOLAN M.S.

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	231H00000X	Audiologist	001796-1	NY

General Provider Information

NPI Number	:	1710940770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTEN JAYNEMANZER NOLAN M.S.

Provider Business Mailing Address
First Line	:	42 PINEWOOD KNL
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-4758
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 ELMWOOD AVE
Second Line	:	SUITE 400
City	:	ROCHESTER
State	:	NY
Zip	:	14620-3042
Country	:	US
Telephone Number	:	585-271-0680
Fax Number	:

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/08/2007

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