Healthcare Provider Details

I. General information

NPI: 1841901659
Provider Name (Legal Business Name): MARIA ISABELLE DE LEON DIXON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA ISABLELLE ROLDAN DE LEON RN

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 04/04/2023
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 GREEN VALLEY RD STE 101
GREENSBORO NC
27408-7022
US

IV. Provider business mailing address

719 GREEN VALLEY RD STE 101
GREENSBORO NC
27408-7022
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-3600
  • Fax:
Mailing address:
  • Phone: 336-832-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF11220018
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberF11220018
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: