Healthcare Provider Details

I. General information

NPI: 1780900191
Provider Name (Legal Business Name): DESIREE JAMELLA HARDING ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MERIDIAN CENTRE BLVD STE 320
ROCHESTER NY
14618-3981
US

IV. Provider business mailing address

300 MERIDIAN CENTRE BLVD STE 320
ROCHESTER NY
14618-3981
US

V. Phone/Fax

Practice location:
  • Phone: 866-352-2356
  • Fax: 585-463-3105
Mailing address:
  • Phone: 866-352-2356
  • Fax: 585-463-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF305066
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: