Basic Information
| Provider Information | |||||||||
| NPI: | 1679811327 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAKESIDE HEALTH SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 COUNTRY WOOD LNDG | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146264408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859575050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 156 WEST AVE | ||||||||
| Address2: | |||||||||
| City: | BROCKPORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144201229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853956095 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2013 | ||||||||
| LastUpdateDate: | 01/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | NDONGWA | ||||||||
| AuthorizedOfficialFirstName: | FLORENCE | ||||||||
| AuthorizedOfficialMiddleName: | NDIKUM | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 5859575050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | F430661-1 | NY | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.