Provider Demographics
NPI:1902622475
Name:DICKERSON, VANESSA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIE
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11035 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-2528
Mailing Address - Country:US
Mailing Address - Phone:918-344-7007
Mailing Address - Fax:
Practice Address - Street 1:11035 E 38TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-2528
Practice Address - Country:US
Practice Address - Phone:918-344-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK213971164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse