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General NPI Number Information
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NPI Number | 1700103280
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Entity Type | Individual
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Provider Name | JULIE F DICKENS RPA-C
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Gender | Female
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 04/23/2010
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Provider Practice Location Address
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Address Line | 1445 PORTLAND AVE SUITE G-01
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City | ROCHESTER
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State | NY
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Zip | 14621-3036
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Country | US
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Telephone | 585-922-3890
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Fax | 585-266-1083
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Provider Business Mailing Address
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Address Line | 10 HAGEN DR SUITE 310
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City | ROCHESTER
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State | NY
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Zip | 14625-2660
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Country | US
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Telephone | 585-249-1975
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Fax | 585-586-7558
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 003808-1
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License Number State | NY
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