Provider Demographics
NPI:1669871398
Name:DICKERSON, EMILY ANNE (ND)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:ND
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 190930
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-0930
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:11035 KARCHER RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-8200
Practice Address - Country:US
Practice Address - Phone:208-302-6600
Practice Address - Fax:208-302-6655
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMRM-2039207Q00000X
WA175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No175F00000XOther Service ProvidersNaturopath