MEDICARE: GRETCHEN A DICKSON ARNP

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	363L00000X	Nurse Practitioner	AP30004516	WA

General Provider Information

NPI Number	:	1811322456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN A DICKSON ARNP

Provider Business Mailing Address
First Line	:	2102 CARRIAGE ST SW
Second Line	:	SUITE H
City	:	OLYMPIA
State	:	WA
Zip	:	98502-1049
Country	:	US
Telephone Number	:	360-352-0711
Fax Number	:	360-705-5048

Provider Business Practice Location Address
First Line	:	2102 CARRIAGE ST SW
Second Line	:	SUITE H
City	:	OLYMPIA
State	:	WA
Zip	:	98502-1049
Country	:	US
Telephone Number	:	360-352-0711
Fax Number	:	360-705-5048

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

Provider Enumeration Date	:	09/12/2013
Last Update Date	:	05/24/2016

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