Provider Demographics
NPI:1699291518
Name:HAVRANEK, AMY (RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HAVRANEK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 COOLEY RD
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-7947
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9503 STATE ROUTE 53
Practice Address - Street 2:
Practice Address - City:PRATTSBURG
Practice Address - State:NY
Practice Address - Zip Code:14873
Practice Address - Country:US
Practice Address - Phone:607-622-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY735159163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse