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NPI Code Detail

MEDICARE: ANGELINE REBECCA TREFFRY DICKERSON

MEDICARE: ANGELINE REBECCA TREFFRY DICKERSON
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
1163WA0400XAddiction (Substance Use Disorder) Registered Nurse201390813OR

General Provider Information

NPI Number : 1811853518
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELINE REBECCA TREFFRY DICKERSON
Provider Business Mailing Address
First Line : 24140 BLISS RD
Second Line :
City : SPRAGUE RIVER
State : OR
Zip : 97639-8644
Country : US
Telephone Number : 503-507-4277
Fax Number :
Provider Business Practice Location Address
First Line : 2555 MAIN ST
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97601-2723
Country : US
Telephone Number : 541-883-2795
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2025
Last Update Date : 12/27/2025

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Directions to “ ANGELINE REBECCA TREFFRY DICKERSON ” Practice Location

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