Provider Demographics
NPI:1790474559
Name:DIXON, TERESA ANN (RN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:DIXON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 9TH AVE S STE 110
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-3825
Mailing Address - Country:US
Mailing Address - Phone:208-369-6467
Mailing Address - Fax:208-463-4516
Practice Address - Street 1:120 9TH AVE S STE 110
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3825
Practice Address - Country:US
Practice Address - Phone:208-369-6467
Practice Address - Fax:208-463-4516
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID27459163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse