MEDICARE: DICKSON ATEKA

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
1	163W00000X	Registered Nurse	229901-3	MN

General Provider Information

NPI Number	:	1578042495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DICKSON ATEKA

Provider Business Mailing Address
First Line	:	7714 BROOKLYN BLVD STE 202C
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-2988
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7714 BROOKLYN BLVD STE 202C
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-2988
Country	:	US
Telephone Number	:	763-234-4459
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2018
Last Update Date	:	08/10/2018

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Directions to “ DICKSON ATEKA ” Practice Location

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