Provider Demographics
NPI:1427195023
Name:DICKS, SHARON P (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:P
Last Name:DICKS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 IMPERIAL DR
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-3222
Mailing Address - Country:US
Mailing Address - Phone:315-737-7950
Mailing Address - Fax:
Practice Address - Street 1:198 COLLEGE HILL RD
Practice Address - Street 2:TB RUDD HEALTH CENTER
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323
Practice Address - Country:US
Practice Address - Phone:315-859-4111
Practice Address - Fax:315-859-4963
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330571-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily