Organization
DIXON FAMILY MEDICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONIQUE BIANCA DECLOUET-DIXON FNP (FAMILY NURSE PRACTITIONER)
(337) 628-5014
Entity
Organization
Contact information
Practice address
536 ST. LANDRY VETERANS MEMORIAL HWY., WASHINGTON, LA 70589-4420
(337) 628-5014
(337) 826-5401
Mailing address
PO BOX 596, WASHINGTON, LA 70589-0596
(337) 628-5014
(337) 826-5401
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
AP05959
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1820105
—
LA
Enumeration date
11/03/2014
Last updated
09/18/2015
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