1396073821 NPI number — DR. DAWN NIXON PSY.D.

Table of content: DR. DAWN NIXON PSY.D. (NPI 1396073821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396073821 NPI number — DR. DAWN NIXON PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIXON
Provider First Name:
DAWN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396073821
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
86360 VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54814-4557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-779-5030
Provider Business Mailing Address Fax Number:
715-779-5046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
88385 PIKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54814-4818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-779-5030
Provider Business Practice Location Address Fax Number:
715-779-5046
Provider Enumeration Date:
11/20/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  2809-057 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)