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Contact Information

PANDORA B DICKSON
7400 122ND AVE N
CHAMPLIN, MN55316-2127
 Phone: 763-458-2415
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family

363LF0000X 50 Nurse Practitioner
 

Medical-Surgical

163WM0705X
Indicates primary specialty

NPI Profile & details for PANDORA B DICKSON · (Female)

NPI # 1578101747
Status Active
Credentials
Entity Individual
Enumeration date 12/18/2019
Last updated 06/14/2023 - About 3 years ago
Sole proprietor 1 Yes
Identifiers
  • MN License # 7270
  • MN License # R188972-5
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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