Healthcare Provider Details

I. General information

NPI: 1265892970
Provider Name (Legal Business Name): DEBORAH LANDERS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH ASHLEY JOHNSTEN

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 LONG POND RD STE 220
ROCHESTER NY
14626-4135
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-3506
  • Fax: 585-368-3163
Mailing address:
  • Phone: 585-368-3506
  • Fax: 585-368-3163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number307439
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: