MEDICARE: LINDA DICKINSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	22674394	NY

General Provider Information

NPI Number	:	1447676507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA DICKINSON RN

Provider Business Mailing Address
First Line	:	8272 MAIN STREET EXT
Second Line	:
City	:	HAMMONDSPORT
State	:	NY
Zip	:	14840-9701
Country	:	US
Telephone Number	:	607-569-5200
Fax Number	:	607-569-5212

Provider Business Practice Location Address
First Line	:	8272 MAIN STREET EXT
Second Line	:
City	:	HAMMONDSPORT
State	:	NY
Zip	:	14840-9701
Country	:	US
Telephone Number	:	607-569-5200
Fax Number	:	607-569-5212

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2014
Last Update Date	:	03/13/2014

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