Provider Demographics
NPI:1467451948
Name:DIXON, JUDY ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ANN
Last Name:DIXON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5733 2ND ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-7225
Mailing Address - Country:US
Mailing Address - Phone:847-688-5568
Mailing Address - Fax:847-688-4413
Practice Address - Street 1:RTC GREAT LAKES BLDG 1523
Practice Address - Street 2:
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088
Practice Address - Country:US
Practice Address - Phone:847-688-5568
Practice Address - Fax:847-688-4413
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse