Provider Demographics
NPI:1528595832
Name:DICKINSON, TIA (LPN)
Entity Type:Individual
Prefix:MS
First Name:TIA
Middle Name:
Last Name:DICKINSON
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 1:1515 NE LAWRIE TATUM RD
Mailing Address - Street 2:LAWTON INDIAN HOSPITAL
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507
Mailing Address - Country:US
Mailing Address - Phone:580-354-5000
Mailing Address - Fax:580-354-5511
Practice Address - Street 1:1515 NE LAWRIE TATUM RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507
Practice Address - Country:US
Practice Address - Phone:580-354-5000
Practice Address - Fax:580-354-5511
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0047373164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse