MEDICARE: KIMBERLY VOLTA 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	327278	NY

General Provider Information

NPI Number	:	1659814408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY VOLTA LPN

Provider Business Mailing Address
First Line	:	21 STONE FENCE RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-3112
Country	:	US
Telephone Number	:	585-794-8045
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 STONE FENCE RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-3112
Country	:	US
Telephone Number	:	585-794-8045
Fax Number	:

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

Provider Enumeration Date	:	11/28/2016
Last Update Date	:	11/28/2016

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Directions to “ KIMBERLY VOLTA LPN” Practice Location

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