Healthcare Provider Details

I. General information

NPI: 1528943131
Provider Name (Legal Business Name): JAZZMIN DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 N 45TH ST
MILWAUKEE WI
53210-1713
US

IV. Provider business mailing address

2860 N 45TH ST
MILWAUKEE WI
53210-1713
US

V. Phone/Fax

Practice location:
  • Phone: 414-306-0663
  • Fax:
Mailing address:
  • Phone: 414-306-0663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberD2504368963204
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: