Provider Demographics
NPI:1477145514
Name:DIXON, JOY (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25883 STUDENT
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3829
Mailing Address - Country:US
Mailing Address - Phone:313-790-5732
Mailing Address - Fax:
Practice Address - Street 1:25883 STUDENT
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3829
Practice Address - Country:US
Practice Address - Phone:313-790-5732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704328081163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health