Provider Demographics
NPI:1013185545
Name:SHIRLEY A DICKINSON
Entity Type:Organization
Organization Name:SHIRLEY A DICKINSON
Other - Org Name:THE NATURAL LOOK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-322-5584
Mailing Address - Street 1:1355 STATE HIGHWAY 345
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3527
Mailing Address - Country:US
Mailing Address - Phone:315-322-5584
Mailing Address - Fax:
Practice Address - Street 1:1355 STATE HIGHWAY 345
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-9658
Practice Address - Country:US
Practice Address - Phone:315-322-5584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0661190001Medicare NSC