Provider Demographics
NPI:1316476773
Name:DICKSON, EVELYN LORRAINE (VOLUNTEER DRIVER)
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:LORRAINE
Last Name:DICKSON
Suffix:
Gender:F
Credentials:VOLUNTEER DRIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 ALLISON DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-4704
Mailing Address - Country:US
Mailing Address - Phone:757-288-4596
Mailing Address - Fax:757-337-5197
Practice Address - Street 1:2116 ALLISON DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23325
Practice Address - Country:US
Practice Address - Phone:757-288-4596
Practice Address - Fax:757-337-5197
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver