MEDICARE: MRS. ANGELA DIXON CRNP

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	363LF0000X	Family Nurse Practitioner	353009	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770983652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA DIXON CRNP

Provider Business Mailing Address
First Line	:	600 IVY ST STE 206
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14905-1627
Country	:	US
Telephone Number	:	607-271-2050
Fax Number	:	607-271-2071

Provider Business Practice Location Address
First Line	:	200 MADISON AVE STE 1D
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-3219
Country	:	US
Telephone Number	:	607-873-1832
Fax Number	:	607-873-1833

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

Provider Enumeration Date	:	08/28/2014
Last Update Date	:	03/09/2026

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