Healthcare Provider Details

I. General information

NPI: 1427195023
Provider Name (Legal Business Name): SHARON P. DICKS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 COLLEGE HILL RD TB RUDD HEALTH CENTER
CLINTON NY
13323
US

IV. Provider business mailing address

57 IMPERIAL DR
NEW HARTFORD NY
13413-3222
US

V. Phone/Fax

Practice location:
  • Phone: 315-859-4111
  • Fax: 315-859-4963
Mailing address:
  • Phone: 315-737-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number330571-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: