MEDICARE: MRS. BONNIE LEE MARSHALL

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	673963	NY

General Provider Information

NPI Number	:	1699287623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BONNIE LEE MARSHALL

Provider Business Mailing Address
First Line	:	75 HAVILAND PARK
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14616-4232
Country	:	US
Telephone Number	:	585-752-4224
Fax Number	:

Provider Business Practice Location Address
First Line	:	2245 ENGLISH RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14616-1651
Country	:	US
Telephone Number	:	585-227-3325
Fax Number	:

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

Provider Enumeration Date	:	10/31/2017
Last Update Date	:	10/31/2017

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