Provider Demographics
NPI:1972827228
Name:DIXON, DARA AMIRAH (LPN)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:AMIRAH
Last Name:DIXON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 NORTH AVE
Mailing Address - Street 2:APT 9
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-3427
Mailing Address - Country:US
Mailing Address - Phone:347-615-0236
Mailing Address - Fax:
Practice Address - Street 1:484 NORTH AVE
Practice Address - Street 2:APT 9
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-3427
Practice Address - Country:US
Practice Address - Phone:347-615-0236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291561-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse