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NPI Code Detail

MEDICARE: LISA MICHELE MALBOUF FNP-C

MEDICARE: LISA MICHELE MALBOUF FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner339062NY

General Provider Information

NPI Number : 1063882926
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MICHELE MALBOUF FNP-C
Provider Business Mailing Address
First Line : 1000 SOUTH AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14620-2782
Country : US
Telephone Number : 585-755-7720
Fax Number :
Provider Business Practice Location Address
First Line : 1000 SOUTH AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14620-2782
Country : US
Telephone Number : 585-755-7720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2015
Last Update Date : 01/20/2023

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