Healthcare Provider Details

I. General information

NPI: 1982901955
Provider Name (Legal Business Name): JOANNE DIBAUDO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 ALEXANDER ST
ROCHESTER NY
14607-4000
US

IV. Provider business mailing address

224 ALEXANDER ST
ROCHESTER NY
14607-4000
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-7200
  • Fax: 585-922-7225
Mailing address:
  • Phone: 585-922-7200
  • Fax: 585-922-7225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number357981-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number357981-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number357981-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: