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General NPI Number Information
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NPI Number | 1306115761
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Entity Type | Organization
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Legal Business Name | BOCES
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 41 OCONNOR RD
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City | FAIRPORT
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State | NY
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Zip | 14450-1327
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Country | US
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Telephone | 585-377-4660
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Fax |
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Provider Business Mailing Address
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Address Line | 41 OCONNOR RD
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City | FAIRPORT
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State | NY
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Zip | 14450-1327
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Country | US
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Telephone | 585-377-4660
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Fax |
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Authorized Official
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Title or Position | NURSE
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Name | MRS. VALERIE LYNN DUNBAR CRENSHAW
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Credential | LPN
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Telephone | 585-663-6533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 2244591
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License Number State | NY
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