Individual
MARY ELLEN DICKINSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
C-PNP
Contact information
Practice address
370 OAK ST, SUITE A, BROCKTON, MA 02301-1341
(508) 584-1234
(508) 584-0230
Mailing address
91 UPLAND RD, PLYMPTON, MA 02367-1602
(781) 585-1631
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
216258
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70010000NP9823
BLUE CROSS BLUE SHIELD
MA
Enumeration date
08/24/2005
Last updated
07/08/2007
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