Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 0001070569 | VA |
NPI | 1306226618 |
---|---|
Provider Name | Alia Renee Dixon |
First Address | Henrico, VA 23228-2662 |
Second Address | Richmond, VA 23224-2078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2015 |
Last Update Date | 09/07/2019 |