Provider Demographics
NPI:1902453814
Name:DICKINSON, RONDA (DNP)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1609
Mailing Address - Country:US
Mailing Address - Phone:989-356-2400
Mailing Address - Fax:989-354-2606
Practice Address - Street 1:109 S 13TH AVE
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1609
Practice Address - Country:US
Practice Address - Phone:989-356-2400
Practice Address - Fax:989-354-2606
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704225008363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health