Provider Demographics
NPI:1679748792
Name:DIXON, GLORIA JEAN
Entity type:Individual
Prefix:MISS
First Name:GLORIA
Middle Name:JEAN
Last Name:DIXON
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 1:1424 ELLSWORTH AVE
Mailing Address - Street 2:1424 ELLSORTH AVE
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-3228
Mailing Address - Country:US
Mailing Address - Phone:614-542-0515
Mailing Address - Fax:
Practice Address - Street 1:1424 ELLSWORTH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-3228
Practice Address - Country:US
Practice Address - Phone:614-542-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2531004374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide