Individual
NICOLE DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1345 NW 15TH ST, LINCOLN CITY, OR 97367-3327
(541) 574-9570
(541) 574-8857
Mailing address
PO BOX 1538, NEWPORT, OR 97365-0115
(541) 574-9570
(541) 574-8857
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
22-CRM-1313
OR
Other
Enumeration date
08/17/2023
Last updated
08/17/2023
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