Healthcare Provider Details

I. General information

NPI: 1720144660
Provider Name (Legal Business Name): DARLENE M DICKSON RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CES 55 450 ST. PAULS PLACE
BRONX NY
10456
US

IV. Provider business mailing address

1219 SHAKESPEARE AVE
BRONX NY
10452-3902
US

V. Phone/Fax

Practice location:
  • Phone: 718-696-4060
  • Fax:
Mailing address:
  • Phone: 718-696-4060
  • Fax: 718-538-0698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF380994
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: