Healthcare Provider Details

I. General information

NPI: 1720641731
Provider Name (Legal Business Name): NAA DICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 CHERRY HILL RD
BROOKLYN MD
21225-1228
US

IV. Provider business mailing address

669 BEL AIR RD # 1152
BEL AIR MD
21014-4306
US

V. Phone/Fax

Practice location:
  • Phone: 443-869-5522
  • Fax:
Mailing address:
  • Phone: 410-908-0944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR208379
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR208379
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: