Healthcare Provider Details

I. General information

NPI: 1699972349
Provider Name (Legal Business Name): JANET MARIE DICKERSON L.P.C.C., R.N.,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 W MARKET ST
TIFFIN OH
44883-2720
US

IV. Provider business mailing address

149 CLINTON AVE
TIFFIN OH
44883-1632
US

V. Phone/Fax

Practice location:
  • Phone: 419-448-4094
  • Fax:
Mailing address:
  • Phone: 419-448-4019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE. 0003629 SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN. 181935
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: