Provider Demographics
NPI:1417383860
Name:DIX, JESSICA GALE
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:GALE
Last Name:DIX
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 1:1141 FARRAND ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-5410
Mailing Address - Country:US
Mailing Address - Phone:517-410-2699
Mailing Address - Fax:
Practice Address - Street 1:1141 FARRAND ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-5410
Practice Address - Country:US
Practice Address - Phone:517-410-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion