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General NPI Number Information
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NPI Number | 1205694684
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Entity Type | Individual
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Provider Name | VENIECE LYNETTE DICKERSON
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Gender | Female
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Dates
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Enumeration Date | 03/11/2024
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 9500 KENWOOD RD
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City | BLUE ASH
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State | OH
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Zip | 45242-6180
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Country | US
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Telephone | 513-254-6620
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Fax |
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Provider Business Mailing Address
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Address Line | 1757 WELCH LN
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City | CINCINNATI
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State | OH
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Zip | 45240-3537
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Country | US
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Telephone | 513-254-6620
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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 | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | OH-14721-101161
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License Number State | OH
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