Provider Demographics
NPI:1942558671
Name:DIXON, ABBY ROSE (LPN)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:ROSE
Last Name:DIXON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:ROSE
Other - Last Name:MOONSCHEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:165 BUTLER DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-2539
Mailing Address - Country:US
Mailing Address - Phone:585-406-8743
Mailing Address - Fax:
Practice Address - Street 1:15 HIGH MANOR DR APT 2
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9108
Practice Address - Country:US
Practice Address - Phone:585-406-8743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-029-4121164W00000X
NY7359921163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse