Healthcare Provider Details

I. General information

NPI: 1952941494
Provider Name (Legal Business Name): HEIDI LYNN YIP NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6536 ANTHONY DR STE C
VICTOR NY
14564-1419
US

IV. Provider business mailing address

6536 ANTHONY DR STE C
VICTOR NY
14564-1419
US

V. Phone/Fax

Practice location:
  • Phone: 585-433-8050
  • Fax: 585-492-9022
Mailing address:
  • Phone: 585-433-8050
  • Fax: 585-492-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF431619-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: