MEDICARE: MRS. RHONDA WALLACE DIXON WHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	940015	NC
2	363L00000X	Nurse Practitioner	940015	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154446888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RHONDA WALLACE DIXON WHNP

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-316-4979
Fax Number	:	704-316-4978

Provider Business Practice Location Address
First Line	:	4130 CLEMMONS RD
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-7520
Country	:	US
Telephone Number	:	336-765-5470
Fax Number	:	336-499-5428

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	10/04/2023

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