Provider Demographics
NPI:1174782577
Name:DIXON WILLIAMS, MAXINE
Entity type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:DIXON WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 LEE STREET
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-1024
Mailing Address - Country:US
Mailing Address - Phone:516-425-7654
Mailing Address - Fax:516-332-6359
Practice Address - Street 1:45 BAUER AVE
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-1517
Practice Address - Country:US
Practice Address - Phone:516-425-7654
Practice Address - Fax:516-332-6359
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY560861 1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse