Basic Information
Provider Information
NPI: 1346963063
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KLEINHAMMER
FirstName: SARAH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 KINGS HWY S
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146175504
CountryCode: US
TelephoneNumber: 5859221900
FaxNumber:  
Practice Location
Address1: 1415 PORTLAND AVENUE
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146213022
CountryCode: US
TelephoneNumber: 5859229800
FaxNumber: 5859223936
Other Information
ProviderEnumerationDate: 09/20/2022
LastUpdateDate: 10/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X350476NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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