Provider Demographics
NPI:1508623596
Name:DICKIE, LAURIE E
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:E
Last Name:DICKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:E
Other - Last Name:ROBINSON-DICKIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2806 CALDERA BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-2609
Mailing Address - Country:US
Mailing Address - Phone:432-349-9951
Mailing Address - Fax:
Practice Address - Street 1:4400 N MIDLAND DR STE 2610
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3385
Practice Address - Country:US
Practice Address - Phone:432-349-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy