Provider Demographics
NPI:1902995152
Name:DICKINSON, ANDREA L (RNFA)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:L
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9313 MEDICAL PLAZA DR STE 305
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9197
Mailing Address - Country:US
Mailing Address - Phone:843-553-7615
Mailing Address - Fax:843-553-1008
Practice Address - Street 1:9313 MEDICAL PLAZA DR STE 305
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9197
Practice Address - Country:US
Practice Address - Phone:843-553-7615
Practice Address - Fax:843-553-1008
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC66920163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant