Provider Demographics
NPI:1629213152
Name:DIXON, LASHELLE YOLONNE (CRNP)
Entity Type:Individual
Prefix:
First Name:LASHELLE
Middle Name:YOLONNE
Last Name:DIXON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 TALBOTT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-3922
Mailing Address - Country:US
Mailing Address - Phone:410-660-1035
Mailing Address - Fax:
Practice Address - Street 1:40 S DUNDALK AVE STE 400
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-4273
Practice Address - Country:US
Practice Address - Phone:410-220-0720
Practice Address - Fax:410-862-0150
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR155151363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417268000Medicaid