Active NPI
Danielle Dickerson, RN
- Registered Nurse
- Mentor on the Lake, OH
National Provider Identifier
1578863189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN314787
- Practice address
- 5782 Andrews Rd
#C-105
Mentor on the Lake, OH 44060-2670 - Phone
- (216) 256-0273
- NPI assigned
- Oct 28, 2010
- Last updated
- Sep 13, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN314787 | OH | Primary |
Addresses
Primary practice location
5782 Andrews Rd
#C-105
Mentor on the Lake, OH 44060-2670
Mailing address
5782 Andrews Rd
#C-105
Mentor on the Lake, OH 44060-2670
Phone (216) 256-0273
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN314787 | OH | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347494400000",
"number": "1578863189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5782 ANDREWS RD",
"address_2": "#C-105",
"city": "MENTOR ON THE LAKE",
"state": "OH",
"postal_code": "440602670",
"telephone_number": "216-256-0273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5782 ANDREWS RD",
"address_2": "#C-105",
"city": "MENTOR ON THE LAKE",
"state": "OH",
"postal_code": "440602670",
"telephone_number": "216-256-0273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKERSON",
"first_name": "DANIELLE",
"name_prefix": "Miss",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-10-28",
"last_updated": "2012-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OH",
"license": "RN314787",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mentor on the Lake, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.