Provider Demographics
NPI:1528800109
Name:BOVENZI, ERIN ELIZABETH (FNP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ELIZABETH
Last Name:BOVENZI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CHARING CROSS
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3926
Mailing Address - Country:US
Mailing Address - Phone:585-978-0035
Mailing Address - Fax:
Practice Address - Street 1:3400 MONROE AVE STE 16
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4725
Practice Address - Country:US
Practice Address - Phone:585-203-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY704838163W00000X
NY351066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse