MEDICARE: COURTNEY JO REMMEL LPN

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	164W00000X	Licensed Practical Nurse	336835	NY

General Provider Information

NPI Number	:	1598362592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY JO REMMEL LPN

Provider Business Mailing Address
First Line	:	410 SHORE ACRES DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14612-5811
Country	:	US
Telephone Number	:	585-490-0076
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 SHORE ACRES DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14612-5811
Country	:	US
Telephone Number	:	585-490-0076
Fax Number	:

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

Provider Enumeration Date	:	10/03/2020
Last Update Date	:	10/03/2020

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