Healthcare Provider Details

I. General information

NPI: 1346492782
Provider Name (Legal Business Name): MS. TANENA L. DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 BRANCH AVE SE
WASHINGTON DC
20020-3337
US

IV. Provider business mailing address

2111 BRANCH AVE SE
WASHINGTON DC
20020-3337
US

V. Phone/Fax

Practice location:
  • Phone: 202-276-6063
  • Fax:
Mailing address:
  • Phone: 202-276-6063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberPT2464
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: