Provider Demographics
NPI:1629841267
Name:DICKERSON, MICHELLE LEA (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LEA
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13827 VILLAGE PLACE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3503
Mailing Address - Country:US
Mailing Address - Phone:804-924-2429
Mailing Address - Fax:
Practice Address - Street 1:6372 MECHANICSVILLE TPKE STE 101
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4710
Practice Address - Country:US
Practice Address - Phone:804-522-1471
Practice Address - Fax:804-522-1472
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024188660208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice