Provider Demographics
NPI:1942457346
Name:CROMWELL, PHILENE MARIE (RN, MS, PNP)
Entity Type:Individual
Prefix:
First Name:PHILENE
Middle Name:MARIE
Last Name:CROMWELL
Suffix:
Gender:F
Credentials:RN, MS, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 WINTON RD S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2905
Mailing Address - Country:US
Mailing Address - Phone:585-214-1522
Mailing Address - Fax:
Practice Address - Street 1:3111 WINTON RD S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2905
Practice Address - Country:US
Practice Address - Phone:585-214-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381186251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health