Provider Demographics
NPI:1891584074
Name:LASHITE-DIXON, CORDELIA R (RN)
Entity type:Individual
Prefix:
First Name:CORDELIA
Middle Name:R
Last Name:LASHITE-DIXON
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 BOWIE LN
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6414
Mailing Address - Country:US
Mailing Address - Phone:972-277-7072
Mailing Address - Fax:
Practice Address - Street 1:35 SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2021
Practice Address - Country:US
Practice Address - Phone:972-277-7072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY872128163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse