Individual
MRS. MICHELE RENEE DICKISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1250 IDAHO ST, LEWISTON, ID 83501-1965
(208) 743-7427
(208) 743-7421
Mailing address
PO BOX 816, 415 6TH ST, LEWISTON, ID 83501-0816
(208) 743-7427
(208) 743-7421
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP-1551A
ID
Other
Enumeration date
04/24/2015
Last updated
04/24/2015
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