Provider Demographics
NPI:1700377363
Name:DIXON, CHEVELL (LVN)
Entity Type:Individual
Prefix:
First Name:CHEVELL
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 LONESOME PINE RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7300
Mailing Address - Country:US
Mailing Address - Phone:903-746-9033
Mailing Address - Fax:
Practice Address - Street 1:168 LONESOME PINE RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7300
Practice Address - Country:US
Practice Address - Phone:903-746-9033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-19
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility