Healthcare Provider Details

I. General information

NPI: 1417559790
Provider Name (Legal Business Name): JEAN MARIE DIXON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOCELYN RAGONESE HEALTH SYSTEMS SPECI

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CENTER PORTSMOUTH 620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2197
US

IV. Provider business mailing address

2000 TRIDENT WAY BLDG 624
SAN DIEGO CA
92155-5599
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-3000
  • Fax:
Mailing address:
  • Phone: 559-381-1279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001249414
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: