Provider Demographics
NPI:1760023428
Name:DICKERMAN, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:DICKERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9503 AUTUMN LEAF WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-5561
Mailing Address - Country:US
Mailing Address - Phone:775-409-0474
Mailing Address - Fax:
Practice Address - Street 1:9503 AUTUMN LEAF WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-5561
Practice Address - Country:US
Practice Address - Phone:775-409-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide