Provider Demographics
NPI:1225188964
Name:DICKINSON, NIKEYSHA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:NIKEYSHA
Middle Name:MARIE
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:NIKEYSHA
Other - Middle Name:MARIE
Other - Last Name:PODSIEDLIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:7490 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9450
Mailing Address - Country:US
Mailing Address - Phone:315-409-4799
Mailing Address - Fax:
Practice Address - Street 1:7490 RIVER RD
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9450
Practice Address - Country:US
Practice Address - Phone:315-409-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02677145164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse