Individual
CHRISTINE LESLIE PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1099 JAY ST BLDG P, ROCHESTER, NY 14611-1164
(585) 325-3580
Mailing address
84 JAMES MOORE CIR, HILTON, NY 14468-9416
(585) 355-3149
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
722626
NY
Other
Enumeration date
10/11/2022
Last updated
10/11/2022
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