Provider Demographics
NPI:1184055931
Name:DIXON, SUE LILLIAN (WHNP-BC)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:LILLIAN
Last Name:DIXON
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 S.W. 4TH ST.
Mailing Address - Street 2:STE.C
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741
Mailing Address - Country:US
Mailing Address - Phone:541-475-4456
Mailing Address - Fax:541-475-0132
Practice Address - Street 1:715 S.W. 4TH ST.
Practice Address - Street 2:STE.C
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741
Practice Address - Country:US
Practice Address - Phone:541-475-4456
Practice Address - Fax:541-475-0132
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR086006332N7363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health