Individual
MARIE DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
950 MATTHEW DRIVE, WAYNESBORO, MS 39367
(601) 735-7102
(601) 735-7168
Mailing address
950 MATTHEW DRIVE, P O BOX 1249, WAYNESBORO, MS 39367
(601) 735-7102
(601) 735-7168
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R110100
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00017439
—
MS
Enumeration date
03/14/2006
Last updated
11/03/2010
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