Healthcare Provider Details

I. General information

NPI: 1043295215
Provider Name (Legal Business Name): JANICE MARIE KOCHEVAR RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 FAWN RDG
MILLWOOD NY
10546-1119
US

IV. Provider business mailing address

32 FAWN RDG
MILLWOOD NY
10546-1119
US

V. Phone/Fax

Practice location:
  • Phone: 914-815-1087
  • Fax:
Mailing address:
  • Phone: 914-815-1087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number368670
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: