=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437864915
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELE MARIE CHENG RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2023
-----------------------------------------------------
Last Update Date | 01/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 WESTFALL RD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14620-4647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-753-5150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 495 WOOD HARBOR TRL
-----------------------------------------------------
City | WEBSTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14580-4085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-410-4549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WG0000X
-----------------------------------------------------
Taxonomy Name | General Practice Registered Nurse
-----------------------------------------------------
License Number | 500621-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------