Provider Demographics
NPI:1104854082
Name:HOSSENLOPP, MARY ELIZABETH (FNP)
Entity Type:Individual
Prefix:
First Name:MARY ELIZABETH
Middle Name:
Last Name:HOSSENLOPP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 LONG POND RD
Mailing Address - Street 2:WEGMAN COTTAGES
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-368-4631
Mailing Address - Fax:585-368-4635
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:WEGMAN COTTAGES
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-368-4631
Practice Address - Fax:585-368-4635
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332219363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02665070Medicaid
NY02665070Medicaid
RA0291Medicare ID - Type Unspecified
S75738Medicare UPIN
NY02665070Medicaid