Healthcare Provider Details

I. General information

NPI: 1396591251
Provider Name (Legal Business Name): JULIE A JEROME RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 10/13/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7995 CALL PKWY STE 100
BATAVIA NY
14020-4114
US

IV. Provider business mailing address

7995 CALL PKWY STE 100
BATAVIA NY
14020-4114
US

V. Phone/Fax

Practice location:
  • Phone: 585-345-1770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number354624
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number616788
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: