Provider Demographics
NPI:1033903596
Name:DICKERSON, COURTNEY RENEE (BSN, RN, CDCES)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RENEE
Last Name:DICKERSON
Suffix:
Gender:
Credentials:BSN, RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 GLENN MITCHELL DR STE 500
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0179
Mailing Address - Country:US
Mailing Address - Phone:757-689-5104
Mailing Address - Fax:757-689-2717
Practice Address - Street 1:2075 GLENN MITCHELL DR STE 500
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0179
Practice Address - Country:US
Practice Address - Phone:757-689-5104
Practice Address - Fax:757-689-2717
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001256561163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator