Provider Demographics
NPI:1477151470
Name:DICKSON, CHARLI J (LVN)
Entity Type:Individual
Prefix:
First Name:CHARLI
Middle Name:J
Last Name:DICKSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 ACR 463
Mailing Address - Street 2:
Mailing Address - City:MONTALBA
Mailing Address - State:TX
Mailing Address - Zip Code:75853
Mailing Address - Country:US
Mailing Address - Phone:903-724-1019
Mailing Address - Fax:
Practice Address - Street 1:1833 ACR 463
Practice Address - Street 2:
Practice Address - City:MONTALBA
Practice Address - State:TX
Practice Address - Zip Code:75853
Practice Address - Country:US
Practice Address - Phone:903-724-1019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX312856164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse