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NPI Code Detail

MEDICARE: MS. CALETHA DICKS CRNA

MEDICARE: MS. CALETHA DICKS CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist32122NY

General Provider Information

NPI Number : 1083619373
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CALETHA DICKS CRNA
Provider Business Mailing Address
First Line : 3555 BAINBRIDGE AVE
Second Line : APT 6C
City : BRONX
State : NY
Zip : 10467-1453
Country : US
Telephone Number : 718-881-1195
Fax Number :
Provider Business Practice Location Address
First Line : 111 E 210TH ST
Second Line :
City : BRONX
State : NY
Zip : 10467-2401
Country : US
Telephone Number : 718-920-4316
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 07/08/2007

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Directions to “ MS. CALETHA DICKS CRNA” Practice Location

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