Provider Demographics
NPI:1780986992
Name:DIXON, JOYCE ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:ANN
Last Name:DIXON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:LAKEMONT
Mailing Address - State:NY
Mailing Address - Zip Code:14857
Mailing Address - Country:US
Mailing Address - Phone:607-275-1737
Mailing Address - Fax:
Practice Address - Street 1:5129 LAKEMONT-HIMROD ROAD
Practice Address - Street 2:
Practice Address - City:LAKEMONT
Practice Address - State:NY
Practice Address - Zip Code:14857
Practice Address - Country:US
Practice Address - Phone:607-275-1737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199152-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01-751-459Medicaid