Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 335614 | VA |
NPI | 1023773983 |
---|---|
Provider Name | Dr. Dianna Dixon |
First Address | Manassas Park, VA 20111-7234 |
Second Address | Manassas Park, VA 20111-7234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2021 |
Last Update Date | 05/11/2021 |