Provider Demographics
NPI:1629036397
Name:DIX, PATRICIA (ANP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:DIX
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 W ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5704
Mailing Address - Country:US
Mailing Address - Phone:252-752-6101
Mailing Address - Fax:252-752-6600
Practice Address - Street 1:PHYSICIANS EAST UGENT CARE
Practice Address - Street 2:1913 EAST FIRETOWER ROAD
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-8545
Practice Address - Country:US
Practice Address - Phone:252-355-4357
Practice Address - Fax:252-355-4187
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900409363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q00176Medicare UPIN
NC2809656AMedicare ID - Type Unspecified