Healthcare Provider Details

I. General information

NPI: 1134303209
Provider Name (Legal Business Name): CAROL MUCHARD NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 12/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PORTLAND AVE ST. ANN'S COMMUNITY
ROCHESTER NY
14621-3065
US

IV. Provider business mailing address

1500 PORTLAND AVE ST. ANN'S COMMUNITY
ROCHESTER NY
14621-3065
US

V. Phone/Fax

Practice location:
  • Phone: 585-697-6082
  • Fax: 585-342-9166
Mailing address:
  • Phone: 585-697-6082
  • Fax: 585-342-9166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340667-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: