Provider Demographics
NPI:1780188722
Name:DICKERSON, PATRICIA (LPN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:DICKERSON
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 1:1309 BRIDGEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-1616
Mailing Address - Country:US
Mailing Address - Phone:302-629-2300
Mailing Address - Fax:302-629-2305
Practice Address - Street 1:1309 BRIDGEVILLE HWY
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-1616
Practice Address - Country:US
Practice Address - Phone:302-629-2300
Practice Address - Fax:302-629-2305
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0012139164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty