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General NPI Number Information
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NPI Number | 1255359147
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Entity Type | Individual
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Provider Name | LUCINDA IMHOFF RPA-C
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Gender | Female
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 293 W NORTH ST
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City | GENEVA
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State | NY
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Zip | 14456-1530
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Country | US
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Telephone | 315-789-0993
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Fax | 315-789-0281
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Provider Business Mailing Address
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Address Line | 67 KENDALL ST SUITE 200
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City | CLIFTON SPRINGS
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State | NY
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Zip | 14432-9701
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Country | US
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Telephone | 315-462-9482
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Fax | 315-462-5438
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 005799
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License Number State | NY
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