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General NPI Number Information
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NPI Number | 1588174965
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Entity Type | Individual
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Provider Name | GRETCHEN DIXON PA
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Gender | Female
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 3780 MEDINA RD STE 310
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City | MEDINA
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State | OH
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Zip | 44256-9312
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Country | US
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Telephone | 330-725-8441
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Fax | 330-725-8442
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Provider Business Mailing Address
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Address Line | 3780 MEDINA RD STE 310
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City | MEDINA
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State | OH
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Zip | 44256-9312
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Country | US
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Telephone | 330-725-8441
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Fax | 330-725-8442
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.005191RX
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License Number State | OH
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