Provider Demographics
NPI:1225796881
Name:DIXON, LETISHA
Entity Type:Individual
Prefix:
First Name:LETISHA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 G ST NE APT 217
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-7409
Mailing Address - Country:US
Mailing Address - Phone:202-421-1696
Mailing Address - Fax:
Practice Address - Street 1:900 G ST NE APT 217
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7409
Practice Address - Country:US
Practice Address - Phone:202-421-1696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide