Healthcare Provider Details

I. General information

NPI: 1578822003
Provider Name (Legal Business Name): MONIKA KUWAHARA MSN, RN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 07/07/2023
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 WEST HENRIETTA RD.
ROCHESTER NY
14623-2327
US

IV. Provider business mailing address

2613 WEST HENRIETTA RD.
ROCHESTER NY
14623-2327
US

V. Phone/Fax

Practice location:
  • Phone: 585-276-0550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number401273
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF401273
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: