Healthcare Provider Details

I. General information

NPI: 1053375477
Provider Name (Legal Business Name): JACQUELINE PATRICIA DENNISON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 PITTSFORD VICTOR RD PARKVIEW PEDIATRICS, PLLC
PITTSFORD NY
14534-3812
US

IV. Provider business mailing address

1050 PITTSFORD VICTOR RD PARKVIEW PEDIATRICS, PLLC
PITTSFORD NY
14534-3812
US

V. Phone/Fax

Practice location:
  • Phone: 585-383-1160
  • Fax: 585-383-8945
Mailing address:
  • Phone: 585-383-1160
  • Fax: 585-383-8945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF381163
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: