Provider Demographics
NPI:1497319750
Name:DIXON, JANE VANACORE (RDN, CDCES)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:VANACORE
Last Name:DIXON
Suffix:
Gender:F
Credentials:RDN, CDCES
Other - Prefix:
Other - First Name:JVD
Other - Middle Name:NUTRITION
Other - Last Name:COUNSELING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:22 BEECHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-2948
Mailing Address - Country:US
Mailing Address - Phone:973-945-9586
Mailing Address - Fax:
Practice Address - Street 1:22 BEECHWOOD LN
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-2948
Practice Address - Country:US
Practice Address - Phone:973-945-9586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
706504133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
706504OtherCOMMISSION ON DIETETIC REGISTRATION