Provider Demographics
NPI:1306226618
Name:DIXON, ALIA RENEE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ALIA
Middle Name:RENEE
Last Name:DIXON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4024 ALDER GROVE LN
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2662
Mailing Address - Country:US
Mailing Address - Phone:804-219-9646
Mailing Address - Fax:
Practice Address - Street 1:101 COWARDIN AVE STE 101B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-2078
Practice Address - Country:US
Practice Address - Phone:804-405-7522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001201422163W00000X
VA0001070569363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse