Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | AP101054 | ME |
NPI | 1679888721 |
---|---|
Provider Name | Stephen J Dickey |
First Address | Madison, ME 04950-4501 |
Second Address | Madison, ME 04950-4501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2010 |
Last Update Date | 13/08/2010 |