Provider Demographics
NPI:1609431691
Name:DIXON, JENNIFER DEAN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DEAN
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:D
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JENNIFER SPENCER
Mailing Address - Street 1:843 CORALBERRY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4814
Mailing Address - Country:US
Mailing Address - Phone:804-429-7818
Mailing Address - Fax:
Practice Address - Street 1:843 CORALBERRY DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-4814
Practice Address - Country:US
Practice Address - Phone:804-429-7818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program