Provider Demographics
NPI:1326681891
Name:DICKINSON, RITA ANN
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:ANN
Last Name:DICKINSON
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 1:243 RICHARDSON CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CAPITAN
Mailing Address - State:NM
Mailing Address - Zip Code:88316-5300
Mailing Address - Country:US
Mailing Address - Phone:575-354-0044
Mailing Address - Fax:
Practice Address - Street 1:208 PORR DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6713
Practice Address - Country:US
Practice Address - Phone:575-630-1214
Practice Address - Fax:575-630-2083
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care