MEDICARE: MR. WILLIAM NOLAN DICKSON

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1780265132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM NOLAN DICKSON

Provider Business Mailing Address
First Line	:	1430 TULANE AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-2632
Country	:	US
Telephone Number	:	901-262-8563
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 BAUDIN ST APT B
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-7023
Country	:	US
Telephone Number	:	901-262-8563
Fax Number	:

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

Provider Enumeration Date	:	04/17/2021
Last Update Date	:	04/17/2021

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Directions to “ MR. WILLIAM NOLAN DICKSON ” Practice Location

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