Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 4014 | SC |
NPI | 1013243021 |
---|---|
Provider Name | Ashley Marie Dickert |
First Address | North Augusta, SC 29860 |
Second Address | North Augusta, SC 29860 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2009 |
Last Update Date | 29/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP3007 | (05) | SC |