Healthcare Provider Details

I. General information

NPI: 1306100730
Provider Name (Legal Business Name): MICHELLE L OKONIECZNY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE L ORTWEIN FNP-BC

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 WEST AVE
ALBION NY
14411-1522
US

IV. Provider business mailing address

300 WEST AVE
BROCKPORT NY
14420-1118
US

V. Phone/Fax

Practice location:
  • Phone: 585-637-3905
  • Fax: 585-637-2375
Mailing address:
  • Phone: 585-637-3905
  • Fax: 585-637-2375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337330
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: