Healthcare Provider Details

I. General information

NPI: 1316799372
Provider Name (Legal Business Name): KIM DARLENE ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 STATE ST
ROCHESTER NY
14614
US

IV. Provider business mailing address

122 CHERRY RD
ROCHESTER NY
14612
US

V. Phone/Fax

Practice location:
  • Phone: 585-454-3550
  • Fax:
Mailing address:
  • Phone: 585-330-8790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number191101
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: