Provider Demographics
NPI:1700103280
Name:DICKENS, JULIE F (RPA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:F
Last Name:DICKENS
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10 HAGEN DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2660
Mailing Address - Country:US
Mailing Address - Phone:585-249-1975
Mailing Address - Fax:585-586-7558
Practice Address - Street 1:1445 PORTLAND AVE
Practice Address - Street 2:SUITE G-01
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3036
Practice Address - Country:US
Practice Address - Phone:585-922-3890
Practice Address - Fax:585-266-1083
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003808-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical