Provider Demographics
NPI:1437291556
Name:CALNAN, KATHLEEN M (NPP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:CALNAN
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-1410
Mailing Address - Country:US
Mailing Address - Phone:585-368-6900
Mailing Address - Fax:585-368-6955
Practice Address - Street 1:81 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608
Practice Address - Country:US
Practice Address - Phone:585-368-6900
Practice Address - Fax:585-368-6955
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400632363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02246977Medicaid
NY02246977Medicaid
NYCC8385Medicare ID - Type Unspecified70008A GROUP