Individual
MS. KIMBERLY L. PROVENZANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1425 PORTLAND AVE, ROCHESTER, NY 14621-3001
(585) 922-4020
(585) 922-4622
Mailing address
1425 PORTLAND AVE, ROCHESTER, NY 14621-3001
(585) 922-4020
(585) 922-4622
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
370019
NY
364SX0200X
Oncology Clinical Nurse Specialist
370019
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02674220
—
NY
Enumeration date
06/03/2006
Last updated
07/28/2023
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