Healthcare Provider Details

I. General information

NPI: 1487547824
Provider Name (Legal Business Name): PAMELA SUE DIXON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2317 E HOME RD
SPRINGFIELD OH
45503-2520
US

IV. Provider business mailing address

2317 E HOME RD
SPRINGFIELD OH
45503-2520
US

V. Phone/Fax

Practice location:
  • Phone: 937-817-4095
  • Fax: 937-869-0289
Mailing address:
  • Phone: 937-817-4095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN.447299
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: