MEDICARE: DANA DEJOHN NP

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	163W00000X	Registered Nurse	709690	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	404524	NY

General Provider Information

NPI Number	:	1568979086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA DEJOHN NP

Provider Business Mailing Address
First Line	:	300 CRITTENDEN BLVD BOX PSYCH
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0001
Country	:	US
Telephone Number	:	585-275-0609
Fax Number	:

Provider Business Practice Location Address
First Line	:	2613 W HENRIETTA RD STE C
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-2327
Country	:	US
Telephone Number	:	585-275-0609
Fax Number	:

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

Provider Enumeration Date	:	01/05/2018
Last Update Date	:	06/23/2026

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Directions to “ DANA DEJOHN NP” Practice Location

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