Individual
JANE I DICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
809 82ND PKWY, MYRTLE BEACH, SC 29572-4607
(843) 692-1062
Mailing address
PO BOX 1792, COLUMBIA, SC 29202-1792
(843) 692-1062
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R91894
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8051826
—
NC
05
—
AN1222
—
SC
01
—
P00078062
RR MEDICARE
SC
Enumeration date
10/03/2006
Last updated
02/05/2008
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