Healthcare Provider Details

I. General information

NPI: 1710545041
Provider Name (Legal Business Name): MYLES VOLZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2019
Last Update Date: 06/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PARK AVE
ROCHESTER NY
14607-2415
US

IV. Provider business mailing address

25 PARK AVE
ROCHESTER NY
14607-2415
US

V. Phone/Fax

Practice location:
  • Phone: 315-521-1137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number734503
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: