MEDICARE: MRS. BARBARAJEAN CANAWAY F.N.P.

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
1	363LF0000X	Family Nurse Practitioner	F331725-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P019331725	OTHER	NY	RCIPA

General Provider Information

NPI Number	:	1134138209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BARBARAJEAN CANAWAY F.N.P.

Provider Business Mailing Address
First Line	:	1570 LONG POND RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4119
Country	:	US
Telephone Number	:	585-227-0721
Fax Number	:	585-227-8086

Provider Business Practice Location Address
First Line	:	1570 LONG POND RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4119
Country	:	US
Telephone Number	:	585-227-0721
Fax Number	:	585-227-8086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2006
Last Update Date	:	07/02/2010

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