Provider Demographics
NPI:1265918395
Name:SALISBURY, RACHEL ANN (AGPCNP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:SALISBURY
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANN
Other - Last Name:PERUCKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3065
Mailing Address - Country:US
Mailing Address - Phone:585-697-6469
Mailing Address - Fax:585-342-9166
Practice Address - Street 1:1500 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3065
Practice Address - Country:US
Practice Address - Phone:585-697-6469
Practice Address - Fax:585-342-9166
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY632261363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health