Healthcare Provider Details

I. General information

NPI: 1053697623
Provider Name (Legal Business Name): RUSLANA TOKARCHUK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 METRO PARK
ROCHESTER NY
14623-2607
US

IV. Provider business mailing address

85 METRO PARK
ROCHESTER NY
14623-2607
US

V. Phone/Fax

Practice location:
  • Phone: 585-295-6417
  • Fax: 585-672-2527
Mailing address:
  • Phone: 585-295-6417
  • Fax: 585-672-2527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number631685
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: