Provider Demographics
NPI:1356632038
Name:DICKSON, DANA E (RN, BA, CCM)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:E
Last Name:DICKSON
Suffix:
Gender:F
Credentials:RN, BA, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 MEADOW CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1804
Mailing Address - Country:US
Mailing Address - Phone:941-926-1314
Mailing Address - Fax:
Practice Address - Street 1:3909 MEADOW CREEK LN
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1804
Practice Address - Country:US
Practice Address - Phone:941-926-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3255902163W00000X
MN00078598163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management