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Gwenetta Dickerson
NPI 1730681800 · on the registry since 2018 · sole proprietor
Practice
- Address
- 100 Eagle Crk
Collinsville, IL 62234 - Phone
- (314) 933-6369
Registry record
- Primary taxonomy
- 225700000X
225700000X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2018-03-05
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois