Healthcare Provider Details

I. General information

NPI: 1548418171
Provider Name (Legal Business Name): KRISTIN CAPUANO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WHITE SPRUCE BLVD C/O GENESEE VALLEY LASER CENTRE
ROCHESTER NY
14623-1606
US

IV. Provider business mailing address

300 WHITE SPRUCE BLVD C/O GENESEE VALLEY LASER CENTRE
ROCHESTER NY
14623-1606
US

V. Phone/Fax

Practice location:
  • Phone: 585-424-6770
  • Fax: 585-424-6776
Mailing address:
  • Phone: 585-424-6770
  • Fax: 585-424-6776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33554
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: