Provider Demographics
NPI:1306080692
Name:DICKSTEIN, DONNA (RN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:DICKSTEIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:CARATUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04925-0128
Mailing Address - Country:US
Mailing Address - Phone:207-672-4983
Mailing Address - Fax:207-672-4983
Practice Address - Street 1:137 DEER LANE
Practice Address - Street 2:
Practice Address - City:CARATUNK
Practice Address - State:ME
Practice Address - Zip Code:04925
Practice Address - Country:US
Practice Address - Phone:207-672-4983
Practice Address - Fax:207-672-4983
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2011-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER019620163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse