Individual
LISA KOTYRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
601 ELMWOOD AVE, ROCHESTER, NY 14642-0002
(585) 273-3760
(585) 273-1129
Mailing address
601 ELMWOOD AVE, BOX 679B, ROCHESTER, NY 14642-0002
(585) 273-3760
(585) 273-1129
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
424459
NY
363L00000X
Nurse Practitioner
Primary
F301044
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01980198
—
NY
01
—
NP0783
PREFERRED CARE
NY
01
—
P019301044
BLUE CHOICE
NY
Enumeration date
09/15/2006
Last updated
08/26/2011
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