MEDICARE: MISS LEONTE RACHELLE WARREN 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	298257	NY

General Provider Information

NPI Number	:	1639496235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LEONTE RACHELLE WARREN LPN

Provider Business Mailing Address
First Line	:	72YATES
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14609-2431
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	72 YATES ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14609-2227
Country	:	US
Telephone Number	:	585-698-7264
Fax Number	:

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

Provider Enumeration Date	:	04/23/2010
Last Update Date	:	02/22/2012

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