Basic Information
| Provider Information | |||||||||
| NPI: | 1679888721 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DICKEY | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049504501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076963992 | ||||||||
| FaxNumber: | 2076963974 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049504501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076963992 | ||||||||
| FaxNumber: | 2076963974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2010 | ||||||||
| LastUpdateDate: | 08/13/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LC1500X | AP101054 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Community Health |
No ID Information.