Physician Compare National (NPI:1235145715)

HEALTHCARE PROVIDER: HOLLY A DICKSON MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1235145715
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9537298302
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100603000990
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DICKSON
	Individual professional last name
Provider First Name	HOLLY
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TEXAS MEDICAL SCHOOL AT HOUSTON
	Individual professional's medical school
Graduation Year	1997
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	853 WATSON ST N
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 202
	Group Practice or individual's line 2 address
City	ENUMCLAW
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	980223948
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	501335
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST ELIZABETH HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	M