Provider Demographics
NPI:1700407004
Name:WEBB, ETHEL M
Entity Type:Individual
Prefix:
First Name:ETHEL
Middle Name:M
Last Name:WEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24626
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-0626
Mailing Address - Country:US
Mailing Address - Phone:904-655-3737
Mailing Address - Fax:
Practice Address - Street 1:495 ATTRIDGE ROAD
Practice Address - Street 2:2
Practice Address - City:CHURCHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14428-1462
Practice Address - Country:US
Practice Address - Phone:904-655-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor