Healthcare Provider Details

I. General information

NPI: 1740863125
Provider Name (Legal Business Name): JULIA WUEST PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE
ROCHESTER NY
14621-3011
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-4020
  • Fax:
Mailing address:
  • Phone: 585-922-4020
  • Fax: 585-922-4622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number027009
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: