Provider Demographics
NPI:1992737456
Name:DIXON, SUZANNE E (CRNA)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:E
Last Name:DIXON
Suffix:
Gender:F
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:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16804-1230
Mailing Address - Country:US
Mailing Address - Phone:814-235-3898
Mailing Address - Fax:814-235-3899
Practice Address - Street 1:1800 E PARK AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6701
Practice Address - Country:US
Practice Address - Phone:814-231-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN5220562367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50042593OtherCAPITAL BLUE CROSS
PA86169OtherGEISINGER HEALTH PLAN
PA50042593OtherKEYSTONE HEALTH PLAN CENT
PA084338Medicare ID - Type Unspecified
PAP00200524Medicare ID - Type UnspecifiedRAILROAD MEDICARE