Healthcare Provider Details

I. General information

NPI: 1215297858
Provider Name (Legal Business Name): CARLA KAREN FACEY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARLA KAREN LITTREAN

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FALSTAFF ROAD
ROCHESTER NY
14609-1884
US

IV. Provider business mailing address

100 FALSTAFF RD
ROCHESTER NY
14609-5543
US

V. Phone/Fax

Practice location:
  • Phone: 585-305-0801
  • Fax:
Mailing address:
  • Phone: 585-305-0801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number284396-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: