Provider Demographics
NPI:1518143056
Name:BIHRLE, ELLEN TERESA (LICENSED PRACTICAL)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:TERESA
Last Name:BIHRLE
Suffix:
Gender:F
Credentials:LICENSED PRACTICAL
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:TERESA
Other - Last Name:CECERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:257 RENOUF DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624
Mailing Address - Country:US
Mailing Address - Phone:585-235-5293
Mailing Address - Fax:
Practice Address - Street 1:257 RENOUF DRIVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624
Practice Address - Country:US
Practice Address - Phone:585-235-5293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131243164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02636437Medicaid