Provider Demographics
NPI:1083619373
Name:DICKS, CALETHA (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CALETHA
Middle Name:
Last Name:DICKS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 BAINBRIDGE AVE
Mailing Address - Street 2:APT 6C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1453
Mailing Address - Country:US
Mailing Address - Phone:718-881-1195
Mailing Address - Fax:
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-4316
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32122367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered