Provider Demographics
NPI:1821438821
Name:DICKINSON, BRENDA LEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LEE
Last Name:DICKINSON
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 1:117 HOEFLER ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-3417
Mailing Address - Country:US
Mailing Address - Phone:315-516-9201
Mailing Address - Fax:
Practice Address - Street 1:117 HOEFLER ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-3417
Practice Address - Country:US
Practice Address - Phone:315-516-9201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285156-1164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse