MEDICARE: CAROLYN THERESA DIXON CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN361222	OH
2	363LF0000X	Family Nurse Practitioner	COA. 14271-NP	OH

General Provider Information

NPI Number	:	1003153644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN THERESA DIXON CNP

Provider Business Mailing Address
First Line	:	PO BOX 931596
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-1724
Country	:	US
Telephone Number	:	440-449-1540
Fax Number	:	440-460-2833

Provider Business Practice Location Address
First Line	:	36100 EUCLID AVE STE 350
Second Line	:
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-4489
Country	:	US
Telephone Number	:	440-449-1540
Fax Number	:	440-460-2833

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	06/03/2025

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