Provider Demographics
NPI:1568507895
Name:DICKINSON, DOREEN GAIL (RN)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:GAIL
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12234 ROUTE 39
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14129-9712
Mailing Address - Country:US
Mailing Address - Phone:716-532-1268
Mailing Address - Fax:
Practice Address - Street 1:12234 ROUTE 39
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:NY
Practice Address - Zip Code:14129-9712
Practice Address - Country:US
Practice Address - Phone:716-532-1268
Practice Address - Fax:716-532-0116
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4239691163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse