Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 304626 | NY |
NPI | 1003073115 |
---|---|
Provider Name | Beth Lyn Vaccarelli |
First Address | Rochester, NY 14618-3981 |
Second Address | Buffalo, NY 14210-1351 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2008 |
Last Update Date | 28/10/2019 |