Healthcare Provider Details

I. General information

NPI: 1841986403
Provider Name (Legal Business Name): LINDSEY MARIE KERNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0002
US

IV. Provider business mailing address

15 ATKINSON ST APT 2
ROCHESTER NY
14608-2478
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2182
  • Fax:
Mailing address:
  • Phone: 585-820-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number718027
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: