Individual provider Active NPI

Amanda- Kaitlyn Marie Maracle, LPN

  • Licensed Practical Nurse
  • Rochester, NY
National Provider Identifier
1962021519
Registry record updated Apr 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
338147-01 Issued in NY
Practice address
87 Jamestown Ter
Rochester, NY 14615-1117
Phone
(585) 465-0777
NPI assigned
Apr 14, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 23, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 338147-01 NY Primary

Addresses

Primary practice location

87 Jamestown Ter
Rochester, NY 14615-1117

Mailing address

87 Jamestown Ter
Rochester, NY 14615-1117
Phone (585) 465-0777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
338147-01NYMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587600000000",
    "number": "1962021519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "87 JAMESTOWN TER",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146151117",
            "telephone_number": "585-465-0777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87 JAMESTOWN TER",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146151117",
            "telephone_number": "585-465-0777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARACLE",
        "first_name": "AMANDA- KAITLYN",
        "middle_name": "MARIE",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-14",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "338147-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.