Provider Demographics
NPI:1235870098
Name:DICKREDE, MARIAH ANN
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:ANN
Last Name:DICKREDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 MONROE ST STE 232
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3462
Mailing Address - Country:US
Mailing Address - Phone:419-574-9290
Mailing Address - Fax:248-712-4381
Practice Address - Street 1:5151 MONROE ST STE 232
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3462
Practice Address - Country:US
Practice Address - Phone:419-574-9290
Practice Address - Fax:248-712-4381
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist