Healthcare Provider Details

I. General information

NPI: 1831205699
Provider Name (Legal Business Name): JOYCE LORRAINE WIEDRICH NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 613-19
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

56 LOCHNAVAR PKWY
PITTSFORD NY
14534-1430
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2222
  • Fax:
Mailing address:
  • Phone: 585-385-9958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF300052
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: