Healthcare Provider Details

I. General information

NPI: 1902735889
Provider Name (Legal Business Name): ADDISYN JO DICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2160 STATE RD
LANCASTER PA
17601-1812
US

IV. Provider business mailing address

1221 CENTRAL AVE
COLUMBIA PA
17512-1916
US

V. Phone/Fax

Practice location:
  • Phone: 223-287-9000
  • Fax:
Mailing address:
  • Phone: 717-723-7492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN737662
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: