Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 430171 | NY |
NPI | 1093746455 |
---|---|
Provider Name | Michael Pope |
First Address | Rochester, NY 14626-4122 |
Second Address | Rochester, NY 14626-4122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 31/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02708170 | (05) | NY |