Healthcare Provider Details

I. General information

NPI: 1720855182
Provider Name (Legal Business Name): NECHELE DANAE JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 PLYMOUTH AVE S
ROCHESTER NY
14608-2908
US

IV. Provider business mailing address

990 PLYMOUTH AVE S
ROCHESTER NY
14608-2908
US

V. Phone/Fax

Practice location:
  • Phone: 585-514-9054
  • Fax:
Mailing address:
  • Phone: 585-514-9054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number736782
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number342541
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: