Healthcare Provider Details

I. General information

NPI: 1891731170
Provider Name (Legal Business Name): LISA DUBE-WHITEHAIR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 668
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2691
  • Fax: 585-273-3359
Mailing address:
  • Phone: 585-275-0638
  • Fax: 585-273-3359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF420311
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: