MEDICARE: JANET R DICKMANDER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	900199	NC
2	363L00000X	Nurse Practitioner	900199	NC

General Provider Information

NPI Number	:	1356456727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET R DICKMANDER NP

Provider Business Mailing Address
First Line	:	4420 LAKE BOONE TRL STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-7505
Country	:	US
Telephone Number	:	919-784-6818
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 SUNNYBROOK RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1827
Country	:	US
Telephone Number	:	919-334-3900
Fax Number	:	919-250-9280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	03/31/2021

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