Provider Demographics
NPI:1003153644
Name:DIXON, CAROLYN THERESA (CNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:THERESA
Last Name:DIXON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6559 WILSON MILLS RD
Mailing Address - Street 2:106
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-6402
Mailing Address - Country:US
Mailing Address - Phone:440-449-1540
Mailing Address - Fax:440-460-2833
Practice Address - Street 1:6559 WILSON MILLS RD
Practice Address - Street 2:106
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-6402
Practice Address - Country:US
Practice Address - Phone:440-449-1540
Practice Address - Fax:440-460-2833
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA. 14271-NP363LF0000X
OHRN361222163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse