MEDICARE: GEORGANN DICKEY FNP

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	363LA2200X	Adult Health Nurse Practitioner	CNP81080	ME

General Provider Information

NPI Number	:	1669472221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGANN DICKEY FNP

Provider Business Mailing Address
First Line	:	301C US ROUTE 1
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-9701
Country	:	US
Telephone Number	:	207-396-8600
Fax Number	:	207-396-8632

Provider Business Practice Location Address
First Line	:	49 SPRING ST
Second Line	:	2ND FLOOR
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-8926
Country	:	US
Telephone Number	:	202-788-3141
Fax Number	:	207-883-1518

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	10/23/2012

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