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Contact Information

KIMBERLY L PROVENZANO
1425 PORTLAND AVE
ROCHESTER, NY14621-3001
 Phone: 585-922-4020
 Fax: 585-922-4622
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Oncology

364SX0200X 89 Certified Clinical Nurse Specialist
Indicates primary specialty

NPI Profile & details for KIMBERLY L PROVENZANO · (Female)

NPI # 1104864081
Status Active
Credentials
Entity Individual
Enumeration date 06/03/2006
Last updated 07/28/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • NY License # 370019
  • NY Medicaid 02674220
Hospital affiliation(s)
  • ROCHESTER GENERAL HOSPITAL - (Acute Care)
    1425 PORTLAND AVENUE
    ROCHESTER, NY 14621
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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