Healthcare Provider Details

I. General information

NPI: 1467636944
Provider Name (Legal Business Name): ERIKA SIMONE MOBLEY-DIXON L.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 COLUMBIA AVENUE
ROCHESTER NY
14611-3617
US

IV. Provider business mailing address

335 COLUMBIA AVE
ROCHESTER NY
14611-3617
US

V. Phone/Fax

Practice location:
  • Phone: 585-464-0523
  • Fax:
Mailing address:
  • Phone: 585-464-0523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number238515-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: