Provider Demographics
NPI:1841046612
Name:DIXON, LUCY ELIZABETH (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:ELIZABETH
Last Name:DIXON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-3617
Mailing Address - Country:US
Mailing Address - Phone:917-447-9582
Mailing Address - Fax:
Practice Address - Street 1:957 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3617
Practice Address - Country:US
Practice Address - Phone:917-447-9582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY633012-01163WL0100X
NJ26NR18030600163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant