Healthcare Provider Details

I. General information

NPI: 1194379818
Provider Name (Legal Business Name): LAJUANA DIXON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAJUANA LOWE RN

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9059 GARDNER LOOP
TACOMA WA
98433
US

IV. Provider business mailing address

9059 GARDNER LOOP
JBLM WA
98431
US

V. Phone/Fax

Practice location:
  • Phone: 253-363-5598
  • Fax: 253-967-7290
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number0001208627
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001208627
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: