Individual
JENNIFER L DICKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
720 ESKENAZI AVE, INDIANAPOLIS, IN 46202-5166
(317) 880-8211
Mailing address
7258 TRESA DR, INDIANAPOLIS, IN 46239-7853
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71002864A
IN
364S00000X
Clinical Nurse Specialist
28157050A
IN
364SA2200X
Adult Health Clinical Nurse Specialist
28157050A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000604028
ANTHEM
IN
05
—
200931510
—
IN
Enumeration date
07/01/2008
Last updated
06/09/2017
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