Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 4301060673 | MI |
NPI | 1770542797 |
---|---|
Provider Name | Christine Dickinson |
First Address | Royal Oak, MI 48073-6712 |
Second Address | Mount Clemens, MI 48043-2920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 09/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3445124 | (05) | MI |
A37694 | (02) | MI |
CI8050 | MEDICARE RR GROUP PIN (01) | MI |