Provider Demographics
NPI:1154446888
Name:DIXON, RHONDA WALLACE (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:WALLACE
Last Name:DIXON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-4979
Mailing Address - Fax:704-316-4978
Practice Address - Street 1:4130 CLEMMONS RD
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-7520
Practice Address - Country:US
Practice Address - Phone:336-765-5470
Practice Address - Fax:336-499-5428
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC940015363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005570Medicaid
NC2594289Medicare PIN