Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 120051 | NE |
NPI | 1104105709 |
---|---|
Provider Name | Mary W. Dickerson |
First Address | Lincoln, NE 68510-2469 |
Second Address | Lincoln, NE 68510-2469 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2011 |
Last Update Date | 06/02/2013 |