Healthcare Provider Details

I. General information

NPI: 1669181996
Provider Name (Legal Business Name): JOSHUA DIXON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 E WILLETTA ST
PHOENIX AZ
85006-2723
US

IV. Provider business mailing address

995 E DIXON DR
SAFFORD AZ
85546-8183
US

V. Phone/Fax

Practice location:
  • Phone: 480-581-3900
  • Fax:
Mailing address:
  • Phone: 808-341-1186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number239596
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: