Provider Demographics
NPI:1356396261
Name:NOWICKY, LENORE THERESA (MS RN GNP)
Entity type:Individual
Prefix:MS
First Name:LENORE
Middle Name:THERESA
Last Name:NOWICKY
Suffix:
Gender:F
Credentials:MS RN GNP
Other - Prefix:MS
Other - First Name:LENORE
Other - Middle Name:THERESA
Other - Last Name:NOWICKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:435 E HENRIETTA RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4629
Mailing Address - Country:US
Mailing Address - Phone:585-760-6352
Mailing Address - Fax:585-760-6376
Practice Address - Street 1:435 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4629
Practice Address - Country:US
Practice Address - Phone:585-760-6352
Practice Address - Fax:585-760-6376
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340511363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03509813Medicaid
NY70005AMedicare PIN
NY03509813Medicaid
NYJ400081129Medicare PIN