Provider Demographics
NPI:1891880423
Name:DIXE, ANNEMARIE (CNP)
Entity Type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:
Last Name:DIXE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 IRVING AVE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1651
Mailing Address - Country:US
Mailing Address - Phone:315-478-1158
Mailing Address - Fax:315-478-3014
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:SUITE 530
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1651
Practice Address - Country:US
Practice Address - Phone:315-478-1158
Practice Address - Fax:315-478-3014
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331653363LF0000X
NY422175163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01932838Medicaid
NY01932838Medicaid