Provider Demographics
NPI:1154486652
Name:DICKERSON, KATHERINE E (RN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34584
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1584
Mailing Address - Country:US
Mailing Address - Phone:509-241-7349
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:5002 KITSAP WAY
Practice Address - Street 2:#206
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-2359
Practice Address - Country:US
Practice Address - Phone:360-782-1700
Practice Address - Fax:360-782-1701
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00040830163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health