Provider Demographics
NPI:1366039141
Name:DIXON, EBONY (REGISTERD NURSE)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:REGISTERD NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 QUEENS CT
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-3514
Mailing Address - Country:US
Mailing Address - Phone:205-421-8644
Mailing Address - Fax:
Practice Address - Street 1:2010 QUEENS CT
Practice Address - Street 2:
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004-3514
Practice Address - Country:US
Practice Address - Phone:205-421-8644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-149344163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty