Provider Demographics
NPI:1598324592
Name:DIXON, TYWANDA REESE
Entity Type:Individual
Prefix:
First Name:TYWANDA
Middle Name:REESE
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WACHUSETT ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-4741
Mailing Address - Country:US
Mailing Address - Phone:978-326-9440
Mailing Address - Fax:978-560-0606
Practice Address - Street 1:16 WACHUSETT ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-4741
Practice Address - Country:US
Practice Address - Phone:978-326-9440
Practice Address - Fax:978-560-0606
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide