Individual
DIXON MWOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2610 E JEFFERSON BLVD, SOUTH BEND, IN 46615-2724
(574) 276-5026
(574) 251-0869
Mailing address
2610 E JEFFERSON BLVD, SOUTH BEND, IN 46615-2724
(574) 276-5026
(574) 251-0869
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
201371060-A
IN
373H00000X
Day Training/Habilitation Specialist
Primary
201371060-A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201371060A
—
IN
05
—
47-3518606
—
IN
Enumeration date
11/17/2022
Last updated
11/30/2022
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