Provider Demographics
NPI:1558188680
Name:DICKSON, ELIZABETH SUSAN (RN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:DICKSON
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 1:5006 SAWHILL DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8583
Mailing Address - Country:US
Mailing Address - Phone:970-389-3745
Mailing Address - Fax:
Practice Address - Street 1:4575 BYRD DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-7198
Practice Address - Country:US
Practice Address - Phone:970-593-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO183432163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice