Individual
MRS. PANDORA BAZEN DICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7400 122ND AVE N, CHAMPLIN, MN 55316-2127
(763) 458-2415
Mailing address
7400 122ND AVE N, CHAMPLIN, MN 55316-2127
(763) 458-2415
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
R188972-5
MN
363LF0000X
Family Nurse Practitioner
Primary
7270
MN
Other
Enumeration date
12/18/2019
Last updated
06/14/2023
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