Provider Demographics
NPI:1366843294
Name:DIXON-JOHNSON, HEDWIG
Entity Type:Individual
Prefix:
First Name:HEDWIG
Middle Name:
Last Name:DIXON-JOHNSON
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 1:108 GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-2009
Mailing Address - Country:US
Mailing Address - Phone:916-769-6949
Mailing Address - Fax:916-927-8231
Practice Address - Street 1:108 GRACE AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-2009
Practice Address - Country:US
Practice Address - Phone:916-769-6949
Practice Address - Fax:916-927-8231
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN124876164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
N/AOtherN/A