Provider Demographics
NPI:1508219106
Name:DICKERSON, ERIKA (NP)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W 136TH ST
Mailing Address - Street 2:2ND FLOOR, KOUNTZ PAVILION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-2104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 W 136TH ST
Practice Address - Street 2:2ND FLOOR, KOUNTZ PAVILION
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-2104
Practice Address - Country:US
Practice Address - Phone:212-939-8078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307826-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health