Healthcare Provider Details

I. General information

NPI: 1558419739
Provider Name (Legal Business Name): KATHRYN ANN ZIENTARA RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2007
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BRANFORD RD
ROCHESTER NY
14618-1739
US

IV. Provider business mailing address

109 BRANFORD RD
ROCHESTER NY
14618-1739
US

V. Phone/Fax

Practice location:
  • Phone: 585-739-5089
  • Fax:
Mailing address:
  • Phone: 585-739-5089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5044
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number005044-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: