Healthcare Provider Details

I. General information

NPI: 1043946429
Provider Name (Legal Business Name): LAURA KOCH CRPA-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 LAKE AVE
ROCHESTER NY
14608-1410
US

IV. Provider business mailing address

81 LAKE AVE
ROCHESTER NY
14608-1410
US

V. Phone/Fax

Practice location:
  • Phone: 585-416-9183
  • Fax:
Mailing address:
  • Phone: 585-416-9183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCRPA-P-4561
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: