Provider Demographics
NPI:1043623424
Name:DICKENSON, EMILY (RN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DICKENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19450 TULSA DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-3462
Mailing Address - Country:US
Mailing Address - Phone:276-591-6566
Mailing Address - Fax:
Practice Address - Street 1:19450 TULSA DR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202-3462
Practice Address - Country:US
Practice Address - Phone:276-591-6566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001204070163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse