Provider Demographics
NPI:1205896610
Name:BIANCHI, MARIE ANN (NP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ANN
Last Name:BIANCHI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RED CREEK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-4300
Mailing Address - Country:US
Mailing Address - Phone:585-244-5670
Mailing Address - Fax:585-338-1477
Practice Address - Street 1:600 RED CREEK DR STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623
Practice Address - Country:US
Practice Address - Phone:585-244-5670
Practice Address - Fax:585-338-1477
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302582363LA2200X
NYF302582-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02049452Medicaid
NYP019302582OtherBLUES
NYNP0026OtherPREFERRED CARE
NYBB8584Medicare ID - Type Unspecified
NYS96419Medicare UPIN