Basic Information
| Provider Information | |||||||||
| NPI: | 1578160800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALHOUN | ||||||||
| FirstName: | LE'JON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 SCARBOROUGH PARK | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146251365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853091875 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 BENEDICT RD | ||||||||
| Address2: | |||||||||
| City: | PITTSFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145343435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853346000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2020 | ||||||||
| LastUpdateDate: | 10/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 339472-01 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.