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NPI Code Detail

MEDICARE: LYSHEMMA DICKSON

MEDICARE: LYSHEMMA 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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1992064216
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYSHEMMA DICKSON
Provider Business Mailing Address
First Line : 1312 DUSTY CREEK ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-2160
Country : US
Telephone Number : 702-271-0776
Fax Number :
Provider Business Practice Location Address
First Line : 1312 DUSTY CREEK ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-2160
Country : US
Telephone Number : 702-271-0776
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2012
Last Update Date : 05/07/2012

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Directions to “ LYSHEMMA DICKSON ” Practice Location

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