Provider Demographics
NPI:1982904447
Name:DIXON, LESTER CHARLES (RN)
Entity Type:Individual
Prefix:MR
First Name:LESTER
Middle Name:CHARLES
Last Name:DIXON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-5408
Mailing Address - Country:US
Mailing Address - Phone:917-531-1972
Mailing Address - Fax:
Practice Address - Street 1:402 E 156TH ST
Practice Address - Street 2:NURSING OFFICE-3RD FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-1232
Practice Address - Country:US
Practice Address - Phone:917-531-1972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334660163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse