Healthcare Provider Details

I. General information

NPI: 1467859306
Provider Name (Legal Business Name): DIXIE LEE COLGAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 HANOVER PIKE FL 1
HAMPSTEAD MD
21074-1319
US

IV. Provider business mailing address

2111 HANOVER PIKE FL 1
HAMPSTEAD MD
21074-1319
US

V. Phone/Fax

Practice location:
  • Phone: 410-374-9500
  • Fax: 410-374-5311
Mailing address:
  • Phone: 410-374-9500
  • Fax: 410-374-5311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR090458
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: