Provider Demographics
NPI:1023125044
Name:DICKIE, CAROLYN GWYN (NP)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:GWYN
Last Name:DICKIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W 11TH ST
Mailing Address - Street 2:TPF
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8305
Mailing Address - Country:US
Mailing Address - Phone:212-219-2677
Mailing Address - Fax:212-431-2594
Practice Address - Street 1:121 W 11TH ST
Practice Address - Street 2:TPF
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8305
Practice Address - Country:US
Practice Address - Phone:212-219-2677
Practice Address - Fax:212-431-2594
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301485363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner