Healthcare Provider Details

I. General information

NPI: 1598542664
Provider Name (Legal Business Name): MARSHA LUCILLE ECKERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 CHURCHILL DRIVE
ROCHESTER NY
14616
US

IV. Provider business mailing address

92 CHURCHILL DR
ROCHESTER NY
14616-2151
US

V. Phone/Fax

Practice location:
  • Phone: 585-454-3550
  • Fax:
Mailing address:
  • Phone: 585-478-5157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number135211
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: