Provider Demographics
NPI:1649550476
Name:DIXON, ALYSIA (NNP-BC)
Entity type:Individual
Prefix:
First Name:ALYSIA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 758997
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-8997
Mailing Address - Country:US
Mailing Address - Phone:804-828-2841
Mailing Address - Fax:804-628-0783
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:PEDIATRICS
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-827-1475
Practice Address - Fax:804-828-8559
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169610363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care