Provider Demographics
NPI:1043536386
Name:PROULX, PATRICIA ANN (RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:PROULX
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 STRAWBERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623
Mailing Address - Country:US
Mailing Address - Phone:585-454-3550
Mailing Address - Fax:
Practice Address - Street 1:150 STATE ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14614-1353
Practice Address - Country:US
Practice Address - Phone:585-454-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223667-1163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse