Provider Demographics
NPI:1720144660
Name:DICKSON, DARLENE M (RNP)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:M
Last Name:DICKSON
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 SHAKESPEARE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-3902
Mailing Address - Country:US
Mailing Address - Phone:718-696-4060
Mailing Address - Fax:718-538-0698
Practice Address - Street 1:CES 55
Practice Address - Street 2:450 ST. PAULS PLACE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456
Practice Address - Country:US
Practice Address - Phone:718-696-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380994363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner