Provider Demographics
NPI:1437163714
Name:DIXON-MURRIELL, CHARMANE DIANA (RN,APN,C)
Entity Type:Individual
Prefix:MRS
First Name:CHARMANE
Middle Name:DIANA
Last Name:DIXON-MURRIELL
Suffix:
Gender:F
Credentials:RN,APN,C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:1104 ROUTE 130 N
Practice Address - Street 2:SUITE K
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3032
Practice Address - Country:US
Practice Address - Phone:856-786-8010
Practice Address - Fax:856-786-0529
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00114100363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0116297Medicaid
NJ0116297Medicaid
NJQ76226Medicare UPIN