Healthcare Provider Details

I. General information

NPI: 1629638515
Provider Name (Legal Business Name): CHLOE HAYES INGALLS WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 07/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 SOUTH AVE STE 103
ROCHESTER NY
14620-2740
US

IV. Provider business mailing address

990 SOUTH AVE STE 10
ROCHESTER NY
14620-2762
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-0101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421386
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF421386-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: