Individual
ANDREE GLANETTE DICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4100 W 3RD ST, DAYTON, OH 45428-9000
(937) 268-6511
Mailing address
237 KENILWORTH AVE, DAYTON, OH 45405-4009
(937) 830-7875
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
124430
OH
Other
Enumeration date
05/21/2008
Last updated
05/21/2008
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