Healthcare Provider Details

I. General information

NPI: 1235507161
Provider Name (Legal Business Name): MRS. SANDRA G WITMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CRITTENDEN BLVD
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

300 CRITTENDEN BLVD BOX PSYCH
ROCHESTER NY
14642-8409
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-3569
  • Fax: 585-273-1066
Mailing address:
  • Phone: 585-275-3569
  • Fax: 585-273-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number212825
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: