Healthcare Provider Details

I. General information

NPI: 1801678560
Provider Name (Legal Business Name): JANISA MARIE LYNCH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 BELLWOOD DR STE 1
ROCHESTER NY
14606-4226
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 704
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-453-2700
  • Fax:
Mailing address:
  • Phone: 585-275-5830
  • Fax: 585-475-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number311586
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: