| NPI | 1063539823 |
|---|---|
| Former Name | SYREETA LYNN DICKERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2015039584) |
| Additional Taxonomies | 171W00000X Contractor (Licence: KS 200380880A) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: KS 77550-072) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MO 2015039584) | |
| Enumeration Date | 2007-03-24 |
| Last Update Date | 2022-02-16 |