Provider Demographics
NPI:1083623524
Name:MCNAMARA, JOANNE MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:MARIE
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 648
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-8849
Mailing Address - Fax:585-273-1033
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 652
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-8849
Practice Address - Fax:585-273-1033
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY309642363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS94843Medicare UPIN
NYRA9031Medicare ID - Type Unspecified