Provider Demographics
NPI:1417565102
Name:PROFETTA, ALISSA JEAN (NP)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:JEAN
Last Name:PROFETTA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-3937
Mailing Address - Fax:
Practice Address - Street 1:973 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2216
Practice Address - Country:US
Practice Address - Phone:585-244-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-19
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF346115-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily