Individual
TRACY DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2801 BAY PARK DR, OREGON, OH 43616-4920
(419) 690-7900
(419) 697-7726
Mailing address
1 SEAGATE # 800, TOLEDO, OH 43604-1558
(419) 690-7900
(419) 697-7726
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN.CRNA.10348
OH
367500000X
Certified Registered Nurse Anesthetist
RN219439
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2940438
—
OH
01
—
P00689517
TRAVELERS RR MEDICARE
OH
05
—
PENDING
—
OH
Enumeration date
10/31/2008
Last updated
02/04/2020
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