Provider Demographics
NPI:1619587953
Name:DIXON, JENETTA FELICIA (ASCP CERTIFICATION)
Entity Type:Individual
Prefix:
First Name:JENETTA
Middle Name:FELICIA
Last Name:DIXON
Suffix:
Gender:F
Credentials:ASCP CERTIFICATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BONAIR ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2797
Mailing Address - Country:US
Mailing Address - Phone:540-455-0775
Mailing Address - Fax:
Practice Address - Street 1:107 BONAIR ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-2797
Practice Address - Country:US
Practice Address - Phone:540-455-0775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA46298202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology