1891087771 NPI number — MS. ROSAMOND M REFFELL-PUGH FNP

Table of content: MS. ROSAMOND M REFFELL-PUGH FNP (NPI 1891087771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891087771 NPI number — MS. ROSAMOND M REFFELL-PUGH FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REFFELL-PUGH
Provider First Name:
ROSAMOND
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891087771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 CARTER STREET
Provider Second Line Business Mailing Address:
LIFETIME HEALTH MEDICAL GROUP
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14621-2607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-338-1200
Provider Business Mailing Address Fax Number:
585-544-1359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 CARTER STREET
Provider Second Line Business Practice Location Address:
LIFETIME HEALTH MEDICAL GROUP
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14621-2607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-338-1200
Provider Business Practice Location Address Fax Number:
585-544-1359
Provider Enumeration Date:
05/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC1500X , with the licence number:  6368461 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 340186 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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