Provider Demographics
NPI:1699710699
Name:HIXSON, DANIEL R (CNP)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:R
Last Name:HIXSON
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-3210
Mailing Address - Country:US
Mailing Address - Phone:440-357-6740
Mailing Address - Fax:440-357-7906
Practice Address - Street 1:7 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3210
Practice Address - Country:US
Practice Address - Phone:440-357-6740
Practice Address - Fax:440-357-7906
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06505363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2304474Medicaid
P53844Medicare UPIN
NP05841Medicare ID - Type Unspecified