Provider Demographics
NPI:1922559640
Name:DICKERSON, WENDY S (NMD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:S
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4527 E EXETER BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2813
Mailing Address - Country:US
Mailing Address - Phone:480-390-7017
Mailing Address - Fax:
Practice Address - Street 1:3301 N MILLER RD STE 130
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6457
Practice Address - Country:US
Practice Address - Phone:480-980-5794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16-1561175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath