Provider Demographics
NPI:1154971455
Name:DIX, AKELA (LPN)
Entity type:Individual
Prefix:
First Name:AKELA
Middle Name:
Last Name:DIX
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DEPOSIT
Mailing Address - State:NY
Mailing Address - Zip Code:13754-1024
Mailing Address - Country:US
Mailing Address - Phone:607-621-9175
Mailing Address - Fax:
Practice Address - Street 1:52 4TH ST
Practice Address - Street 2:
Practice Address - City:DEPOSIT
Practice Address - State:NY
Practice Address - Zip Code:13754-1024
Practice Address - Country:US
Practice Address - Phone:607-621-9175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330063164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse