Healthcare Provider Details

I. General information

NPI: 1407093644
Provider Name (Legal Business Name): KIMBERLY LYNN OLRICH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5639 W GENESEE ST
CAMILLUS NY
13031-1250
US

IV. Provider business mailing address

2585 NAUGHTON RD
LA FAYETTE NY
13084-9765
US

V. Phone/Fax

Practice location:
  • Phone: 315-468-6840
  • Fax:
Mailing address:
  • Phone: 315-677-3012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF335684-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: