Healthcare Provider Details

I. General information

NPI: 1144555905
Provider Name (Legal Business Name): KEVIN NEARY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 604
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 604
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-1385
  • Fax: 585-244-7271
Mailing address:
  • Phone: 585-275-1385
  • Fax: 585-244-7271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number485521-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: