Healthcare Provider Details

I. General information

NPI: 1588628622
Provider Name (Legal Business Name): DARLENE D BREZINSKY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MAIN ST
PENN YAN NY
14527-1204
US

IV. Provider business mailing address

PO BOX 423
PENN YAN NY
14527-0423
US

V. Phone/Fax

Practice location:
  • Phone: 315-536-2752
  • Fax: 315-536-4005
Mailing address:
  • Phone: 315-531-9102
  • Fax: 315-531-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF300695-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: