Provider Demographics
NPI:1710285069
Name:DIXON, CHILANT RENEE (BSHS)
Entity Type:Individual
Prefix:
First Name:CHILANT
Middle Name:RENEE
Last Name:DIXON
Suffix:
Gender:F
Credentials:BSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6171 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1126
Mailing Address - Country:US
Mailing Address - Phone:702-486-6138
Mailing Address - Fax:702-486-8029
Practice Address - Street 1:6171 W CHARLESTON BLVD
Practice Address - Street 2:#16
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1126
Practice Address - Country:US
Practice Address - Phone:702-486-6138
Practice Address - Fax:702-486-8029
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator