Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 00562 | NM |
NPI | 1023257037 |
---|---|
Provider Name | Gloria Dixon |
First Address | Albuquerque, NM 87106-4374 |
Second Address | Albuquerque, NM 87106-4383 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2009 |
Last Update Date | 13/09/2021 |