Individual
JACOB WILLIAM DICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, BSN
Contact information
Practice address
300 BROADWAY, SOMERVILLE, MA 02145-2935
(617) 284-7000
(617) 284-7010
Mailing address
5457 GREENTON WAY, SAINT LOUIS, MO 63128-3849
(314) 799-3350
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN-TEMP4044
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN-TEMP4044
RN
MA
Enumeration date
01/05/2021
Last updated
01/05/2021
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