Individual
MRS. AMARA DONELLA DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
9410 CALUMET AVE STE 401, MUNSTER, IN 46321-0018
(219) 922-4900
(219) 836-9922
Mailing address
9410 CALUMET AVE STE 401, MUNSTER, IN 46321-0018
(219) 922-4900
(219) 836-9922
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71007595A
IN
363LA2100X
Acute Care Nurse Practitioner
Primary
71007595A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300011528
—
IN
Enumeration date
11/03/2017
Last updated
08/13/2024
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