Provider Demographics
NPI:1851732812
Name:CLEARY, LORRAINE (ANP)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:
Last Name:CLEARY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WAYNE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2733
Mailing Address - Country:US
Mailing Address - Phone:585-752-1972
Mailing Address - Fax:
Practice Address - Street 1:25 WAYNE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2733
Practice Address - Country:US
Practice Address - Phone:585-752-1972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-07
Last Update Date:2013-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306067-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health