Healthcare Provider Details

I. General information

NPI: 1689354763
Provider Name (Legal Business Name): MAURA T ARMEZZANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

101 LONG BRANCH CIR
LIVERPOOL NY
13090-3257
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-4551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number432753
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: