Healthcare Provider Details

I. General information

NPI: 1558076950
Provider Name (Legal Business Name): GLORIELA ELEIDA BURNS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WESTFALL RD
ROCHESTER NY
14620-4647
US

IV. Provider business mailing address

111 WESTFALL RD
ROCHESTER NY
14620-4680
US

V. Phone/Fax

Practice location:
  • Phone: 585-753-5100
  • Fax:
Mailing address:
  • Phone: 585-753-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number0768449
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: