Individual
PENNY VANOSDOL DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
206 PARK PLACE BLVD., KISSIMMEE, FL 34741-2344
(407) 846-0023
(407) 483-1064
Mailing address
206 PARK PLACE BLVD., KISSIMMEE, FL 34741-2344
(407) 846-0023
(407) 483-1064
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
751022500
—
FL
Enumeration date
02/05/2007
Last updated
11/10/2010
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