Provider Demographics
NPI:1790918142
Name:DICKERSON, NORMA JEAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NORMA
Middle Name:JEAN
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 1:17847 TOWNSHIP ROAD 65B
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-9061
Mailing Address - Country:US
Mailing Address - Phone:740-327-7033
Mailing Address - Fax:
Practice Address - Street 1:17847 TOWNSHIP ROAD 65B
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-9061
Practice Address - Country:US
Practice Address - Phone:740-327-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-127115-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse