Provider Demographics
NPI:1225334857
Name:DIXON-THEISLER, ANDREA LYN (CNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LYN
Last Name:DIXON-THEISLER
Suffix:
Gender:F
Credentials:CNS-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6605 COUNTRY RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-5556
Mailing Address - Country:US
Mailing Address - Phone:330-272-5911
Mailing Address - Fax:330-744-1728
Practice Address - Street 1:540 PARMALEE AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1716
Practice Address - Country:US
Practice Address - Phone:330-744-4360
Practice Address - Fax:330-744-1728
Is Sole Proprietor?:No
Enumeration Date:2011-01-29
Last Update Date:2011-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.11698-NS364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist