Individual
TARA MARIE DICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7822 DAVENPORT ST, OMAHA, NE 68114-3629
(402) 391-4855
(402) 391-6818
Mailing address
7822 DAVENPORT ST, OMAHA, NE 68114-3629
(402) 391-4855
(402) 391-6818
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
77804
NE
367500000X
Certified Registered Nurse Anesthetist
Primary
101576
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
77804
RN LICENSE
NE
Enumeration date
04/15/2020
Last updated
06/02/2022
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