Healthcare Provider Details

I. General information

NPI: 1972851749
Provider Name (Legal Business Name): LYNN DICKINSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 CURIE BLVD
PHILADELPHIA PA
19104-4217
US

IV. Provider business mailing address

408D CURIE BLVD
PHILADELPHIA PA
19104-3906
US

V. Phone/Fax

Practice location:
  • Phone: 215-886-3758
  • Fax:
Mailing address:
  • Phone: 215-886-3758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberSP000781B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: