Healthcare Provider Details

I. General information

NPI: 1134347263
Provider Name (Legal Business Name): SHIRLEY PATRICIA DIXON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

791 AQUAHART RD 3RD FLOOR
GLEN BURNIE MD
21061-3961
US

IV. Provider business mailing address

430 RED BIRCH RD
MILLERSVILLE MD
21108-1414
US

V. Phone/Fax

Practice location:
  • Phone: 410-222-6838
  • Fax: 410-222-6840
Mailing address:
  • Phone: 410-987-4621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR123158
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: