Provider Demographics
NPI:1801403514
Name:DIX, DIANE LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNN
Last Name:DIX
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 COUNTRY LN
Mailing Address - Street 2:STE 300
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-3408
Mailing Address - Country:US
Mailing Address - Phone:906-361-3154
Mailing Address - Fax:
Practice Address - Street 1:1000 COUNTRY LN
Practice Address - Street 2:STE 300
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-3408
Practice Address - Country:US
Practice Address - Phone:906-361-3154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-26
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704234177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily