Provider Demographics
NPI:1801556360
Name:DIXON, SHANISE (CPRP,HSM,MBA)
Entity type:Individual
Prefix:
First Name:SHANISE
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:CPRP,HSM,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 COOKE ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-3304
Mailing Address - Country:US
Mailing Address - Phone:410-553-1649
Mailing Address - Fax:
Practice Address - Street 1:341 COOKE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-3304
Practice Address - Country:US
Practice Address - Phone:410-946-4746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-26
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRSA-01558374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide