Healthcare Provider Details

I. General information

NPI: 1043534019
Provider Name (Legal Business Name): DIXIE ANN ST. JOHN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 H ST 100
ANCHORAGE AK
99501-3446
US

IV. Provider business mailing address

711 H ST 100
ANCHORAGE AK
99501-3446
US

V. Phone/Fax

Practice location:
  • Phone: 907-770-0862
  • Fax:
Mailing address:
  • Phone: 907-770-0862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number27621
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: