Healthcare Provider Details

I. General information

NPI: 1194785055
Provider Name (Legal Business Name): CAROLINE BURTNER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 LONG POND RD
ROCHESTER NY
14626-4122
US

IV. Provider business mailing address

1555 LONG POND RD
ROCHESTER NY
14626-4122
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-4007
  • Fax:
Mailing address:
  • Phone: 585-368-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF000003
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: