Provider Demographics
NPI:1396077194
Name:ORTIZ, ANN MARIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 NORTHAVEN TER
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-5518
Mailing Address - Country:US
Mailing Address - Phone:585-313-5327
Mailing Address - Fax:
Practice Address - Street 1:347 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-2617
Practice Address - Country:US
Practice Address - Phone:585-454-4930
Practice Address - Fax:585-325-6059
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227376164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY227376OtherLICENSE