Basic Information
| Provider Information | |||||||||
| NPI: | 1235224056 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DICKERSON | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | ALICE | ||||||||
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| Credential: | RNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 LAIR LN | ||||||||
| Address2: | |||||||||
| City: | BAILEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804212089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038832268 | ||||||||
| FaxNumber: | 3033935050 | ||||||||
| Practice Location | |||||||||
| Address1: | 1055 CLERMONT ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033998020 | ||||||||
| FaxNumber: | 3033935050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 88062 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.