Doctor Name: | SARA DICKERSON |
NPI Number: | 1659616571 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN BSN |
License Number: | 201041867RN |
Business Practice Address: | 29984 Ellensburg Ave Gold Beach, OR - 97444 |
Business Phone Number: | 5412477084 |
Business Fax Number: | |
Mailing Address: | Po Box 493, GOLD BEACH |
State: | OR |
Postal Code: | 974440493 |
Phone Number: | 5412477084 |
Fax Number: | |
NPI Enumeration Date: | 12/04/2012 |
NPI Last Update Date: | 01/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WW0000X |
License Number: | 201041867RN |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Wound Care |
Taxonomy Definition: |