Provider Demographics
NPI:1295021327
Name:DICK, DEANNA ALBO (LM, CPM)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:ALBO
Last Name:DICK
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4328
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-4328
Mailing Address - Country:US
Mailing Address - Phone:707-845-7925
Mailing Address - Fax:707-442-3955
Practice Address - Street 1:839 9TH ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6229
Practice Address - Country:US
Practice Address - Phone:707-845-7925
Practice Address - Fax:707-442-3955
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM308176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife