Healthcare Provider Details

I. General information

NPI: 1144378738
Provider Name (Legal Business Name): BRENDA L DIXON APRN, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 CHURCH HILL RD
SANDY HOOK CT
06482-1110
US

IV. Provider business mailing address

82 CHURCH HILL RD
SANDY HOOK CT
06482-1110
US

V. Phone/Fax

Practice location:
  • Phone: 203-249-7993
  • Fax:
Mailing address:
  • Phone: 203-249-7993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF308620-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number003469
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number003469
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: