Healthcare Provider Details

I. General information

NPI: 1992980833
Provider Name (Legal Business Name): ANN LUSK DICKMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 OLEANDER AVE
CHICO CA
95926-3924
US

IV. Provider business mailing address

695 OLEANDER AVE
CHICO CA
95926-3924
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-2736
  • Fax: 530-891-2873
Mailing address:
  • Phone: 530-891-2736
  • Fax: 530-891-2873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number308517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: