Provider Demographics
NPI:1265986996
Name:YOUNG, DIXIE JANE (LPN)
Entity type:Individual
Prefix:
First Name:DIXIE
Middle Name:JANE
Last Name:YOUNG
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 1:935 TOD AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-2827
Mailing Address - Country:US
Mailing Address - Phone:330-974-7104
Mailing Address - Fax:
Practice Address - Street 1:935 TOD AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-2827
Practice Address - Country:US
Practice Address - Phone:330-974-7104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.140538.MEDS.IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse