Healthcare Provider Details

I. General information

NPI: 1972703312
Provider Name (Legal Business Name): MRS. WENDY C KIMBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 WESTFIELD ST
ROCHESTER NY
14619-1547
US

IV. Provider business mailing address

163 WESTFIELD ST
ROCHESTER NY
14619-1547
US

V. Phone/Fax

Practice location:
  • Phone: 585-235-4565
  • Fax:
Mailing address:
  • Phone: 585-755-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10243090
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number10243090
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: