Healthcare Provider Details

I. General information

NPI: 1215901087
Provider Name (Legal Business Name): CAROL DIXON- HUGH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2057
US

IV. Provider business mailing address

2036 RALPH AVE
BROOKLYN NY
11234-5345
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-4744
  • Fax: 718-245-4766
Mailing address:
  • Phone: 718-974-7762
  • Fax: 718-531-6841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number6149
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: