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General NPI Number Information
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NPI Number | 1073775961
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Entity Type | Individual
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Provider Name | JENNIFER L DICKINSON NP
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Gender | Female
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 06/09/2017
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Provider Practice Location Address
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Address Line | 720 ESKENAZI AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5166
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Country | US
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Telephone | 317-880-8211
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Fax |
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Provider Business Mailing Address
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Address Line | 7258 TRESA DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46239-7853
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 28157050A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | 28157050A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71002864A
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License Number State | IN
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