Provider Demographics
NPI:1285869669
Name:DIXON, MICHAEL DOUGLAS (CRNA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:DIXON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W. LAKE MEAD PARKWAY
Mailing Address - Street 2:SUITE B-18
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015
Mailing Address - Country:US
Mailing Address - Phone:702-564-4440
Mailing Address - Fax:
Practice Address - Street 1:129 W LAKE MEAD PKWY
Practice Address - Street 2:SUITE B-18
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7055
Practice Address - Country:US
Practice Address - Phone:702-564-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX703985367500000X
VA0024183179367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered