Basic Information
Provider Information
NPI: 1750667721
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COMERFORD
FirstName: KERI
MiddleName: LYNN
NamePrefix: MRS.
NameSuffix:  
Credential: NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2365 S CLINTON AVE
Address2: SUITE 200
City: ROCHESTER
State: NY
PostalCode: 146182663
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2365 S CLINTON AVE
Address2: SUITE 200
City: ROCHESTER
State: NY
PostalCode: 146182663
CountryCode: US
TelephoneNumber: 5857585700
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/22/2011
LastUpdateDate: 10/22/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X33336751NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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