Provider Demographics
NPI:1265642359
Name:STORY, DIXIE (CM)
Entity Type:Individual
Prefix:MRS
First Name:DIXIE
Middle Name:
Last Name:STORY
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6103 JUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-5821
Mailing Address - Country:US
Mailing Address - Phone:702-453-3299
Mailing Address - Fax:702-452-0384
Practice Address - Street 1:6103 JUDSON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89156-5821
Practice Address - Country:US
Practice Address - Phone:702-453-3299
Practice Address - Fax:702-452-0384
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV602175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV667411OtherPREFERRED PROVIDER ID #