Healthcare Provider Details

I. General information

NPI: 1326089046
Provider Name (Legal Business Name): SANDRA J VANCAMP NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CARTER STREET WILSON HEALTH CENTER
ROCHESTER NY
14621
US

IV. Provider business mailing address

800 CARTER STREET ATTN KELLY STEELE
ROCHESTER NY
14621
US

V. Phone/Fax

Practice location:
  • Phone: 585-338-1400
  • Fax: 585-336-4845
Mailing address:
  • Phone: 585-339-4793
  • Fax: 585-336-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF3000831
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: