Provider Demographics
NPI:1477272904
Name:DIXON, TAHJI RASHAAD
Entity Type:Individual
Prefix:
First Name:TAHJI
Middle Name:RASHAAD
Last Name:DIXON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 N HUMPHREY AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2577
Mailing Address - Country:US
Mailing Address - Phone:708-539-2701
Mailing Address - Fax:
Practice Address - Street 1:178 N HUMPHREY AVE APT 1
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2577
Practice Address - Country:US
Practice Address - Phone:708-539-2701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041441760163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse