Healthcare Provider Details

I. General information

NPI: 1356632038
Provider Name (Legal Business Name): DANA E DICKSON RN, BA, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 MEADOW CREEK LN
SARASOTA FL
34233-1804
US

IV. Provider business mailing address

3909 MEADOW CREEK LN
SARASOTA FL
34233-1804
US

V. Phone/Fax

Practice location:
  • Phone: 941-926-1314
  • Fax:
Mailing address:
  • Phone: 941-926-1314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN3255902
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number00078598
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: