Provider Demographics
NPI:1770696999
Name:ANDERSON, JAMIE L (PAC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BLAKESLEE ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-2209
Mailing Address - Country:US
Mailing Address - Phone:585-260-2222
Mailing Address - Fax:
Practice Address - Street 1:100 CORPORATE WOODS
Practice Address - Street 2:C/O EVERCARE
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1467
Practice Address - Country:US
Practice Address - Phone:585-463-3100
Practice Address - Fax:585-463-3105
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1363363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA2327Medicare PIN