Healthcare Provider Details

I. General information

NPI: 1306876792
Provider Name (Legal Business Name): DONNA J REKKERTH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 05/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 CLINTON AVE S SUITE 200
ROCHESTER NY
14618-2645
US

IV. Provider business mailing address

2365 CLINTON AVE S SUITE 200
ROCHESTER NY
14618-2645
US

V. Phone/Fax

Practice location:
  • Phone: 585-758-5700
  • Fax: 585-758-1293
Mailing address:
  • Phone: 585-758-5700
  • Fax: 585-758-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0601X
TaxonomyOtorhinolaryngology & Head-Neck Registered Nurse
License NumberF332617
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: