Provider Demographics
NPI:1548607898
Name:DIXON, LORI D (RN)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:D
Last Name:DIXON
Suffix:
Gender:F
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:PO BOX 128
Mailing Address - Street 2:116 W. THIRD ST.
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-0128
Mailing Address - Country:US
Mailing Address - Phone:509-565-3405
Mailing Address - Fax:509-565-3400
Practice Address - Street 1:524 S HALLETT
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-0128
Practice Address - Country:US
Practice Address - Phone:509-565-3405
Practice Address - Fax:509-565-3400
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00148211163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse