Healthcare Provider Details

I. General information

NPI: 1568878635
Provider Name (Legal Business Name): LISA MARIE DALTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 E. HENRIETTA RD.
ROCHESTER NY
14620
US

IV. Provider business mailing address

435 E. HENRIETTA RD.
ROCHESTER NY
14620
US

V. Phone/Fax

Practice location:
  • Phone: 585-760-6500
  • Fax:
Mailing address:
  • Phone: 585-760-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number306896
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: