MEDICARE: MRS. REBECCA C. DENNIS FNP

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	363LF0000X	Family Nurse Practitioner	F332709	NY

General Provider Information

NPI Number	:	1598908600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA C. DENNIS FNP

Provider Business Mailing Address
First Line	:	10 LOWER CAMPUS DRIVE
Second Line	:	ALFRED STATE COLLEGE HEALTH SERVICES
City	:	ALFRED
State	:	NY
Zip	:	14802-1137
Country	:	US
Telephone Number	:	607-587-4200
Fax Number	:	607-587-4203

Provider Business Practice Location Address
First Line	:	10 LOWER CAMPUS DRIVE
Second Line	:	ALFRED STATE COLLEGE HEALTH SERVICES
City	:	ALFRED
State	:	NY
Zip	:	14802-1137
Country	:	US
Telephone Number	:	607-587-4200
Fax Number	:	607-587-4203

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

Provider Enumeration Date	:	04/20/2009
Last Update Date	:	04/20/2009

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