MEDICARE: NR WHOLENESS HEALTH

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	1041C0700X	Clinical Social Worker
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1528736311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NR WHOLENESS HEALTH

Provider Business Mailing Address
First Line	:	2604 ELMWOOD AVE STE 299
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-2213
Country	:	US
Telephone Number	:	585-419-7019
Fax Number	:	585-627-0792

Provider Business Practice Location Address
First Line	:	10 CADY ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14608-2322
Country	:	US
Telephone Number	:	585-419-7019
Fax Number	:	585-627-0792

Authorized Official
Title or Position	:	PARTNER
Name	:	NAOMI DOUGLAS DAVIS
Credential	:	LCSW
Telephone Number	:	585-503-2773

Provider Enumeration Date	:	09/06/2021
Last Update Date	:	09/06/2021

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Directions to “NR WHOLENESS HEALTH ” Practice Location

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