National Provider Identifier
Khantalee Souvannavong
Khantalee Souvannavong is listed in the NPPES registry with a primary specialty of Licensed Practical Nurse in Rochester, NY and a listed phone number of (585) 749-0292.
Profile Overview
- NPI
- 1487042560
- Provider Type
- Individual
- Primary Specialty
- Licensed Practical Nurse
- Enumeration Date
- December 25, 2014
- Last Updated
- December 25, 2014
Practice Location
- 185 Country Ln
- Rochester, NY 14626-3307
Phone: (585) 749-0292
Specialties
- Licensed Practical Nurse (164W00000X)
Full Record
- NPI
- 1487042560
- Entity Type
- Individual
- Last Name
- Souvannavong
- First Name
- Khantalee
- Mailing Street Address
- 185 Country Ln
- Mailing City
- Rochester
- Mailing State
- NY
- Mailing ZIP Code
- 14626-3307
- Mailing Country
- US
- Mailing Phone
- (585) 749-0292
- Practice Street Address
- 185 Country Ln
- Practice City
- Rochester
- Practice State
- NY
- Practice ZIP Code
- 14626-3307
- Practice Country
- US
- Practice Phone
- (585) 749-0292
- Enumeration Date
- December 25, 2014
- Last Updated
- December 25, 2014
- Sex
- Female
- Sole Proprietor
- Yes
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Licensed Practical Nurse (164W00000X)