Healthcare Provider Details

I. General information

NPI: 1215688650
Provider Name (Legal Business Name): NICOLE S RIEMER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 02/08/2023
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RED CREEK DR
ROCHESTER NY
14623-4273
US

IV. Provider business mailing address

25 TAREYTON DR
VICTOR NY
14564-1241
US

V. Phone/Fax

Practice location:
  • Phone: 585-486-0901
  • Fax:
Mailing address:
  • Phone: 585-260-3110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349080
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: