Provenzano, Kimberly L.

Provenzano, Kimberly L. is an individual health care provider with primary practice located at 1425 Portland Ave , Rochester NY 14621-3001. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Oncology, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Provenzano, Kimberly L. can be contacted via phone (585) 922-4020.

Contact Information

Primary practice address
1425 Portland Ave Rochester NY 14621-3001
Phone: (585) 922-4020
Fax: (585) 922-4622
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Oncology 364SX0200X 370019 New York
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 370019 New York

Profile Details

NPI number 1104864081
LBN Legal business name Provenzano, Kimberly L.
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 3rd, 2006
Last updated Jul 28th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104864081 NPPES
New York MEDICAID 02674220

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