Provider Demographics
NPI:1629515804
Name:DIXON, AMANDA (CMF)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 ARENDELL ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3318
Mailing Address - Country:US
Mailing Address - Phone:252-622-4506
Mailing Address - Fax:252-622-4512
Practice Address - Street 1:2900 ARENDELL ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3318
Practice Address - Country:US
Practice Address - Phone:252-622-4506
Practice Address - Fax:252-622-4512
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC52596224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter