MEDICARE: MR. LESTER CHARLES DIXON R.N.

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	334660	NY

General Provider Information

NPI Number	:	1982904447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LESTER CHARLES DIXON R.N.

Provider Business Mailing Address
First Line	:	1152 JACKSON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-5408
Country	:	US
Telephone Number	:	917-531-1972
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 E 156TH ST
Second Line	:	NURSING OFFICE-3RD FLOOR
City	:	BRONX
State	:	NY
Zip	:	10455-1232
Country	:	US
Telephone Number	:	917-531-1972
Fax Number	:

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

Provider Enumeration Date	:	10/29/2010
Last Update Date	:	10/29/2010

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