Individual
SARA DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
29984 ELLENSBURG AVE, GOLD BEACH, OR 97444
(541) 247-7084
Mailing address
PO BOX 493, GOLD BEACH, OR 97444-0493
(541) 247-7084
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
201041867RN
OR
363LP2300X
Primary Care Nurse Practitioner
Primary
F06192407
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F06192407
AMERICAN ACADEMY OF NURSE PRACTIONERS
—
Enumeration date
12/04/2012
Last updated
10/27/2020
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