Provider Demographics
NPI:1992184345
Name:DIXON, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 WESTWIND AVE
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-3230
Mailing Address - Country:US
Mailing Address - Phone:612-598-9360
Mailing Address - Fax:952-303-6326
Practice Address - Street 1:563 WESTWIND AVE
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3230
Practice Address - Country:US
Practice Address - Phone:612-598-9360
Practice Address - Fax:952-303-6326
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN376440343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)