Provider Demographics
NPI:1891449930
Name:HOUZE-DIXON, SHANNETTA L (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:SHANNETTA
Middle Name:L
Last Name:HOUZE-DIXON
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:DR
Other - First Name:SHANNETTA
Other - Middle Name:L
Other - Last Name:HOUZE-DIXON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, FNP-BC
Mailing Address - Street 1:PO BOX 87742
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-0742
Mailing Address - Country:US
Mailing Address - Phone:734-756-0877
Mailing Address - Fax:
Practice Address - Street 1:880 W LONG LAKE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-4504
Practice Address - Country:US
Practice Address - Phone:888-562-5442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704308259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily