MEDICARE: GLORIA DIXON NURSE PRACTITIONER

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	00562	NM

General Provider Information

NPI Number	:	1023257037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA DIXON NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	933 BRADBURY DR SE
Second Line	:	SUITE 2222
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4374
Country	:	US
Telephone Number	:	505-272-3120
Fax Number	:	505-272-8060

Provider Business Practice Location Address
First Line	:	2600 YALE BLVD SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4383
Country	:	US
Telephone Number	:	505-272-2800
Fax Number	:

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

Provider Enumeration Date	:	02/13/2009
Last Update Date	:	03/10/2026

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