Provider Demographics
NPI:1053883751
Name:DIXON, AMANDA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:DIXON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6394 THORNBERRY CT STE 820
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-7810
Mailing Address - Country:US
Mailing Address - Phone:513-492-8541
Mailing Address - Fax:513-445-3815
Practice Address - Street 1:6394 THORNBERRY CT STE 820
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7810
Practice Address - Country:US
Practice Address - Phone:513-492-8541
Practice Address - Fax:513-445-3815
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHF12180172OtherTHE AMERICAN ACADEMY OF NURSE PRACTITIONERS
OHAPRN.CNP.024028OtherOHIO BOARD OF NURSING
OH4566116Medicaid