Provider Demographics
NPI:1033589296
Name:DICKENSON, MICHELE (LPN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:DICKENSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1869 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-2623
Mailing Address - Country:US
Mailing Address - Phone:810-841-0693
Mailing Address - Fax:
Practice Address - Street 1:1869 HICKORY RD
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074-2623
Practice Address - Country:US
Practice Address - Phone:810-841-0693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703113527164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse