Healthcare Provider Details

I. General information

NPI: 1497223465
Provider Name (Legal Business Name): BETHANY ROSE FRATE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ELMWOOD AVE
ROCHESTER NY
14620-3042
US

IV. Provider business mailing address

10 EILEEN CIR
ROCHESTER NY
14616-2230
US

V. Phone/Fax

Practice location:
  • Phone: 585-271-0761
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number710934
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: