Provider Demographics
NPI:1689005225
Name:DICKERSON, MARY (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30207 FRANKFORD SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19945-2616
Mailing Address - Country:US
Mailing Address - Phone:302-732-3800
Mailing Address - Fax:302-732-6016
Practice Address - Street 1:30207 FRANKFORD SCHOOL RD
Practice Address - Street 2:
Practice Address - City:FRANKFORD
Practice Address - State:DE
Practice Address - Zip Code:19945-2616
Practice Address - Country:US
Practice Address - Phone:302-732-3800
Practice Address - Fax:302-732-6016
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL-10023320163WS0200X
MDAC003935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WS0200XNursing Service ProvidersRegistered NurseSchool