Healthcare Provider Details

I. General information

NPI: 1770998015
Provider Name (Legal Business Name): LORE MUNIR R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 RIDGEWAY AVE
ROCHESTER NY
14626-4127
US

IV. Provider business mailing address

2350 RIDGEWAY AVE
ROCHESTER NY
14626-4127
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-0928
  • Fax: 585-225-1921
Mailing address:
  • Phone: 585-922-0928
  • Fax: 585-225-1921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number208594-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: