=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568796704
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA LYNNE RIZZO F.N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2009
-----------------------------------------------------
Last Update Date | 05/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 PORTLAND AVE
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14621-3065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-435-5498
-----------------------------------------------------
Fax | 585-463-3105
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 919 S MARBLETOWN RD
-----------------------------------------------------
City | PHELPS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14532-9786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-573-4751
-----------------------------------------------------
Fax | 718-975-3086
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F336021-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------