Healthcare Provider Details

I. General information

NPI: 1922033109
Provider Name (Legal Business Name): ROBERT THOMAS DICKINSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BILTMORE AVE
ASHEVILLE NC
28801-4601
US

IV. Provider business mailing address

5 TAULTON CT
DURHAM NC
27705-5399
US

V. Phone/Fax

Practice location:
  • Phone: 828-213-4502
  • Fax:
Mailing address:
  • Phone: 919-489-3287
  • Fax: 919-402-0432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number097997
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: