Provider Demographics
NPI:1205694684
Name:DICKERSON, VENIECE LYNETTE
Entity type:Individual
Prefix:
First Name:VENIECE
Middle Name:LYNETTE
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VENIECE
Other - Middle Name:LYNETTE
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1757 WELCH LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-3537
Mailing Address - Country:US
Mailing Address - Phone:513-254-6620
Mailing Address - Fax:
Practice Address - Street 1:9500 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6180
Practice Address - Country:US
Practice Address - Phone:513-254-6620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH-14721-101161202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology