Individual
CARLA R JUNGQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3170 WEST ST STE 275, CANANDAIGUA, NY 14424-1711
(585) 341-7575
Mailing address
3170 WEST ST STE 275, CANANDAIGUA, NY 14424-1711
(585) 341-7575
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
331694
NY
363L00000X
Nurse Practitioner
Primary
339960
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02379573
—
NY
Enumeration date
06/30/2006
Last updated
06/11/2024
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