Provider Demographics
NPI:1164680856
Name:DIXON, LORI M (RN, MSN, ANP-BC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:M
Last Name:DIXON
Suffix:
Gender:F
Credentials:RN, MSN, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3301
Mailing Address - Country:US
Mailing Address - Phone:704-872-5019
Mailing Address - Fax:704-872-5019
Practice Address - Street 1:419 COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3301
Practice Address - Country:US
Practice Address - Phone:704-872-5019
Practice Address - Fax:704-872-5019
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5003998363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2330194OtherMEDICARE PTAN