Healthcare Provider Details

I. General information

NPI: 1922114602
Provider Name (Legal Business Name): JOLENE RENEE GRIFFITH RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 SOUTH CLINTON AVE SUITE 610
ROCHESTER NY
14618
US

IV. Provider business mailing address

1815 SOUTH CLINTON AVENUE STE 610
ROCHESTER NY
14618
US

V. Phone/Fax

Practice location:
  • Phone: 585-244-3430
  • Fax: 585-244-3165
Mailing address:
  • Phone: 585-244-3430
  • Fax: 585-244-3165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011350
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: