MEDICARE: MS. AMY JEAN DICKSON LPN

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	164W00000X	Licensed Practical Nurse	223846-1	NY

General Provider Information

NPI Number	:	1932356888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY JEAN DICKSON LPN

Provider Business Mailing Address
First Line	:	26 BEACH AVE
Second Line	:
City	:	AUBURN
State	:	NY
Zip	:	13021-2112
Country	:	US
Telephone Number	:	315-255-4630
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 BEACH AVE
Second Line	:
City	:	AUBURN
State	:	NY
Zip	:	13021-2112
Country	:	US
Telephone Number	:	315-255-4630
Fax Number	:

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

Provider Enumeration Date	:	08/22/2008
Last Update Date	:	08/22/2008

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