Individual
SHARON MARIE KOEP DICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN
Contact information
Practice address
19425 EVANS ST NW, ELK RIVER, MN 55330-1074
(763) 389-7686
Mailing address
19425 EVANS ST NW, ELK RIVER, MN 55330-1074
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R0962504
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
326462300
—
MN
Enumeration date
09/12/2005
Last updated
10/22/2015
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