Provider Demographics
NPI:1124749551
Name:DICKINSON, JOSIE (CNA)
Entity type:Individual
Prefix:MS
First Name:JOSIE
Middle Name:
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39589 COUNTRY MILL RD
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-3106
Mailing Address - Country:US
Mailing Address - Phone:716-507-9549
Mailing Address - Fax:
Practice Address - Street 1:39589 COUNTRY MILL RD
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-3106
Practice Address - Country:US
Practice Address - Phone:716-507-9549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01222307251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01222307OtherCALIFORNIA DEPARTMENT OF PUBLIC HEALTH