Provider Demographics
NPI:1598877912
Name:JUNGJOHANN, LUCINDA ORLEN (GNP)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:ORLEN
Last Name:JUNGJOHANN
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CANAL LANDING BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-5107
Mailing Address - Country:US
Mailing Address - Phone:585-368-4050
Mailing Address - Fax:585-723-6705
Practice Address - Street 1:105 CANAL LANDING BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5107
Practice Address - Country:US
Practice Address - Phone:585-368-4050
Practice Address - Fax:585-723-6705
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340534-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02749975Medicaid
NYJ400180623/GRPBA0017Medicare PIN
NYJ400180620/GRP70008AMedicare PIN
NYG0180227590OtherBCHOICE PHYSICAN GRP
NYP76907Medicare UPIN
NYRA1676Medicare ID - Type UnspecifiedMEDICARE PART B