Provider Demographics
NPI:1003170457
Name:CONANT, NICOLE LARA
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LARA
Last Name:CONANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:CONANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS SPED
Mailing Address - Street 1:653 GREENLEAF MDWS
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-4443
Mailing Address - Country:US
Mailing Address - Phone:607-316-8909
Mailing Address - Fax:
Practice Address - Street 1:41 COLEBROOK DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-2211
Practice Address - Country:US
Practice Address - Phone:585-467-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY834986174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist