Provider Demographics
NPI:1528466539
Name:MARRESE, KRISTEN (RN)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MARRESE
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 1:159 AUTUMN CHAPEL WAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-5303
Mailing Address - Country:US
Mailing Address - Phone:585-727-6605
Mailing Address - Fax:
Practice Address - Street 1:451 E HENRIETTA RD
Practice Address - Street 2:FLOOR 2
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4629
Practice Address - Country:US
Practice Address - Phone:585-753-5927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY609882-1163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics