Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 25MA03976200 | NJ |
N | 208000000X | Pediatrician | 25MA03976200 | NJ |
Y | 208000000X | Pediatrician | 4301104278 | MI |
N | 208000000X | Pediatrician | MA39762 | NJ |
NPI | 1326139270 |
---|---|
Provider Name | Cheryl Dickson |
First Address | Kalamazoo, MI 49008 |
Second Address | Kalamazoo, MI 49008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 21/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2059002 | (05) | NJ |
D20060 | (02) | NJ |