Provider Demographics
NPI:1053817544
Name:DIXON, ROXANNE A
Entity Type:Individual
Prefix:MISS
First Name:ROXANNE
Middle Name:A
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:A
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2080 SIERRA TRL
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1142
Mailing Address - Country:US
Mailing Address - Phone:937-520-2931
Mailing Address - Fax:
Practice Address - Street 1:2080 SIERRA TRL
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1142
Practice Address - Country:US
Practice Address - Phone:937-520-2931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid