Individual
MRS. SHAUNTAE MARIE DIXON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23191 LAWRENCE ST, 23191 LAWRENCE ST, SOUTH BEND, IN 46628-5250
(574) 234-3107
(574) 234-3107
Mailing address
23191 LAWRENCE ST, 23191 LAWRENCE ST, SOUTH BEND, IN 46628-5250
(574) 234-3107
(574) 234-3107
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
1728808
IN
343900000X
Non-emergency Medical Transport (VAN)
Primary
343900000X
IN
Other
Enumeration date
06/17/2008
Last updated
06/17/2008
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