Healthcare Provider Details

I. General information

NPI: 1295017622
Provider Name (Legal Business Name): BECKY KINDELBERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 SAINT PAUL ST
ROCHESTER NY
14621-3156
US

IV. Provider business mailing address

1545 SAINT PAUL ST
ROCHESTER NY
14621-3156
US

V. Phone/Fax

Practice location:
  • Phone: 585-336-5841
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number484561-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: