Provider Demographics
NPI:1366679813
Name:DICKERSON, ANDREA LYN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LYN
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1869 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4198
Mailing Address - Country:US
Mailing Address - Phone:740-407-0581
Mailing Address - Fax:
Practice Address - Street 1:1869 UNION ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4198
Practice Address - Country:US
Practice Address - Phone:740-407-0581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.101964164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse