Provider Demographics
NPI:1326718396
Name:DIXON, DAVONNA NAKIA SHENA
Entity Type:Individual
Prefix:
First Name:DAVONNA
Middle Name:NAKIA SHENA
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 1:837 E 98TH AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2388
Mailing Address - Country:US
Mailing Address - Phone:720-909-5356
Mailing Address - Fax:
Practice Address - Street 1:837 E 98TH AVE APT 401
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2388
Practice Address - Country:US
Practice Address - Phone:720-909-5356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health