Provider Demographics
NPI:1821211467
Name:DIXON, GLORIA
Entity type:Individual
Prefix:MRS
First Name:GLORIA
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 1:115 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PROVIDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:71254-6303
Mailing Address - Country:US
Mailing Address - Phone:318-559-1166
Mailing Address - Fax:318-559-2939
Practice Address - Street 1:115 CHERRY ST
Practice Address - Street 2:
Practice Address - City:LAKE PROVIDENCE
Practice Address - State:LA
Practice Address - Zip Code:71254-6303
Practice Address - Country:US
Practice Address - Phone:318-559-1166
Practice Address - Fax:318-559-2939
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health