Healthcare Provider Details

I. General information

NPI: 1497640387
Provider Name (Legal Business Name): LISA MARIE REEVES LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3238 WINTON RD S # 34
ROCHESTER NY
14623-5968
US

IV. Provider business mailing address

3238 WINTON RD S # 34
ROCHESTER NY
14623-5968
US

V. Phone/Fax

Practice location:
  • Phone: 585-713-5476
  • Fax:
Mailing address:
  • Phone: 585-713-5476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number249545
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: