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NPI Code Detail

MEDICARE: KATHERINE ELLEN DICKINSON MD

MEDICARE: KATHERINE ELLEN DICKINSON MD
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
1207Q00000XFamily Medicine Physician00034326WA

General Provider Information

NPI Number : 1780625467
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE ELLEN DICKINSON MD
Provider Business Mailing Address
First Line : 2604 DONOVAN AVE
Second Line :
City : BELLINGHAM
State : WA
Zip : 98225-7624
Country : US
Telephone Number : 360-961-7904
Fax Number :
Provider Business Practice Location Address
First Line : 1530 ELLIS ST
Second Line :
City : BELLINGHAM
State : WA
Zip : 98225-4905
Country : US
Telephone Number : 360-734-9095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2006
Last Update Date : 01/04/2012

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