Provider Demographics
NPI:1053375477
Name:DENNISON, JACQUELINE PATRICIA (NP)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:PATRICIA
Last Name:DENNISON
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Gender:F
Credentials:NP
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Mailing Address - Street 1:1050 PITTSFORD VICTOR RD
Mailing Address - Street 2:PARKVIEW PEDIATRICS, PLLC
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3812
Mailing Address - Country:US
Mailing Address - Phone:585-383-1160
Mailing Address - Fax:585-383-8945
Practice Address - Street 1:1050 PITTSFORD VICTOR RD
Practice Address - Street 2:PARKVIEW PEDIATRICS, PLLC
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3812
Practice Address - Country:US
Practice Address - Phone:585-383-1160
Practice Address - Fax:585-383-8945
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2010-09-27
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Provider Licenses
StateLicense IDTaxonomies
NYF381163363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY109346DLOtherPREFERRED CARE
NYP019381163OtherEXCELLUS MANAGED CARE