MEDICARE: JANDOLYN A DIXON

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	2025111795	IL

General Provider Information

NPI Number	:	1841159258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANDOLYN A DIXON

Provider Business Mailing Address
First Line	:	15616 CHURCH DR
Second Line	:
City	:	SOUTH HOLLAND
State	:	IL
Zip	:	60473-1537
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15616 CHURCH DR
Second Line	:
City	:	SOUTH HOLLAND
State	:	IL
Zip	:	60473-1537
Country	:	US
Telephone Number	:	312-722-2868
Fax Number	:

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

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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