Provider Demographics
NPI:1942678537
Name:DICKERSON, ANNETTE (APRN)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1121
Mailing Address - Country:US
Mailing Address - Phone:806-725-8000
Mailing Address - Fax:
Practice Address - Street 1:10201 CARNEGIE AVENUE TAUSSIG CANCER CENTER / CA-60
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-1121
Practice Address - Country:US
Practice Address - Phone:216-445-8043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-13
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily