Healthcare Provider Details

I. General information

NPI: 1598877912
Provider Name (Legal Business Name): LUCINDA ORLEN JUNGJOHANN GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CANAL LANDING BLVD SUITE 1
ROCHESTER NY
14626-5107
US

IV. Provider business mailing address

105 CANAL LANDING BLVD SUITE 1
ROCHESTER NY
14626-5107
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-4050
  • Fax: 585-723-6705
Mailing address:
  • Phone: 585-368-4050
  • Fax: 585-723-6705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340534-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: