Provider Demographics
NPI:1033772652
Name:DICKSON, CARI KIM (LPN)
Entity Type:Individual
Prefix:
First Name:CARI
Middle Name:KIM
Last Name:DICKSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:CARI
Other - Middle Name:KIM
Other - Last Name:DICKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:901 RAINIER AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2839
Mailing Address - Country:US
Mailing Address - Phone:206-470-3880
Mailing Address - Fax:
Practice Address - Street 1:901 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2839
Practice Address - Country:US
Practice Address - Phone:206-470-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00055866164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse