Provider Demographics
NPI:1033875521
Name:DILWORTH, SHAWANNA INDONESHIA
Entity Type:Individual
Prefix:MS
First Name:SHAWANNA
Middle Name:INDONESHIA
Last Name:DILWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 S BURLINGTON ST # A
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08030-1909
Mailing Address - Country:US
Mailing Address - Phone:201-598-9565
Mailing Address - Fax:
Practice Address - Street 1:173 S BURLINGTON ST # A
Practice Address - Street 2:
Practice Address - City:GLOUCESTER CITY
Practice Address - State:NJ
Practice Address - Zip Code:08030-1909
Practice Address - Country:US
Practice Address - Phone:201-598-9565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula