Healthcare Provider Details

I. General information

NPI: 1295242162
Provider Name (Legal Business Name): MRS. KARA M. NETTNIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 SCOTTSVILLE RD
ROCHESTER NY
14623-2021
US

IV. Provider business mailing address

2075 SCOTTSVILLE RD
ROCHESTER NY
14623-2021
US

V. Phone/Fax

Practice location:
  • Phone: 585-429-2978
  • Fax: 585-429-2806
Mailing address:
  • Phone: 585-429-2978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: