Healthcare Provider Details

I. General information

NPI: 1790783512
Provider Name (Legal Business Name): LEIGH ANNE CHANDLER GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 MOUNT HOPE AVE
ROCHESTER NY
14620-2251
US

IV. Provider business mailing address

59 VERMONT ST
ROCHESTER NY
14609-4942
US

V. Phone/Fax

Practice location:
  • Phone: 585-546-8400
  • Fax:
Mailing address:
  • Phone: 585-355-4729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340696-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: