Individual
MRS. TANYA DANETTE DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
9104 HWY 81 SOUTH, IVA, SC 29655
(864) 352-6175
(864) 352-2308
Mailing address
P.O. BOX 118, IVA, SC 29655
(864) 348-6196
(864) 348-6198
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
89617
SC
Other
Enumeration date
05/28/2013
Last updated
05/28/2013
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