Healthcare Provider Details

I. General information

NPI: 1841565330
Provider Name (Legal Business Name): KIMBERLEE ANN DIXON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10496 SW BONANZA WAY
TIGARD OR
97224-4339
US

IV. Provider business mailing address

10496 SW BONANZA WAY
TIGARD OR
97224-4339
US

V. Phone/Fax

Practice location:
  • Phone: 503-334-6293
  • Fax:
Mailing address:
  • Phone: 503-334-6293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number082012285 RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: