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General NPI Number Information
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NPI Number | 1023861887
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Entity Type | Individual
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Provider Name | MARIE TATIANA DIXON LPN
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Gender | Female
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Dates
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Enumeration Date | 04/10/2024
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 507 W 145TH ST
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City | NEW YORK
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State | NY
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Zip | 10031-5101
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Country | US
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Telephone | 212-234-1660
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Fax |
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Provider Business Mailing Address
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Address Line | 22705 135TH AVE
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City | LAURELTON
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State | NY
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Zip | 11413-2404
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Country | US
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Telephone | 904-330-7438
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 278015
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License Number State | NY
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