Healthcare Provider Details

I. General information

NPI: 1356583090
Provider Name (Legal Business Name): CASEY LYNN CALABRIA RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WESTFALL RD ROOM 1036
ROCHESTER NY
14620-4647
US

IV. Provider business mailing address

111 WESTFALL RD ROOM 1036
ROCHESTER NY
14620-4647
US

V. Phone/Fax

Practice location:
  • Phone: 585-753-5374
  • Fax: 585-753-5378
Mailing address:
  • Phone: 585-753-5374
  • Fax: 585-753-5378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number604112
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: