Provider Demographics
NPI:1184965865
Name:DICKENS, BRENDA MAY
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:MAY
Last Name:DICKENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7225 E SOUTHGATE DR
Mailing Address - Street 2:D
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2652
Mailing Address - Country:US
Mailing Address - Phone:916-394-1000
Mailing Address - Fax:
Practice Address - Street 1:7225 E SOUTHGATE DR
Practice Address - Street 2:D
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2652
Practice Address - Country:US
Practice Address - Phone:916-394-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program