Individual
TIAWANA E DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1007 KOALA DR, OMAK, WA 98841-9247
(509) 826-6191
(509) 826-3029
Mailing address
1007 KOALA DR, OMAK, WA 98841-9247
(509) 826-6191
(509) 826-3029
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/09/2021
Last updated
09/09/2021
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