Provider Demographics
NPI:1467859306
Name:COLGAN, DIXIE LEE (CRNP)
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:LEE
Last Name:COLGAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 MANCHESTER RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-1850
Mailing Address - Country:US
Mailing Address - Phone:410-374-9500
Mailing Address - Fax:410-374-5311
Practice Address - Street 1:3000 MANCHESTER RD
Practice Address - Street 2:SUITE 5
Practice Address - City:MANCHESTER
Practice Address - State:MD
Practice Address - Zip Code:21102-1850
Practice Address - Country:US
Practice Address - Phone:410-374-9500
Practice Address - Fax:410-374-5311
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR090458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily