Healthcare Provider Details

I. General information

NPI: 1588025407
Provider Name (Legal Business Name): DEBORAH KIM MEAR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2016
Last Update Date: 03/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 DALE RD
ROCHESTER NY
14625-2058
US

IV. Provider business mailing address

169 DALE RD
ROCHESTER NY
14625-2058
US

V. Phone/Fax

Practice location:
  • Phone: 585-381-5631
  • Fax:
Mailing address:
  • Phone: 585-381-5631
  • Fax: 585-387-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number635404
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: