1073655833 NPI number — MS. NANCY ANN DICKSON BSN, MS, CRNA

Table of content: MS. NANCY ANN DICKSON BSN, MS, CRNA (NPI 1073655833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073655833 NPI number — MS. NANCY ANN DICKSON BSN, MS, CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICKSON
Provider First Name:
NANCY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BSN, MS, CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073655833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1128
Provider Second Line Business Mailing Address:
9830 N BAR BOOT RANCH RD
Provider Business Mailing Address City Name:
DOUGLAS
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85608-1128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-824-3121
Provider Business Mailing Address Fax Number:
520-824-3221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2174 W OAK AVE
Provider Second Line Business Practice Location Address:
SOUTHEAST AZ MEDICAL CENTER
Provider Business Practice Location Address City Name:
DOUGLAS
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85607-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-364-7931
Provider Business Practice Location Address Fax Number:
520-364-2551
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN088338 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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