Healthcare Provider Details

I. General information

NPI: 1356040950
Provider Name (Legal Business Name): GLORIA STRADER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SOUTH AVE
ROCHESTER NY
14620-2733
US

IV. Provider business mailing address

1000 SOUTH AVE
ROCHESTER NY
14620-2782
US

V. Phone/Fax

Practice location:
  • Phone: 585-557-2687
  • Fax:
Mailing address:
  • Phone: 585-557-2687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number311192
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: