Provider Demographics
NPI:1073861613
Name:DILLARD, ALEXANDRIA (NP-C)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRIA
Middle Name:
Last Name:DILLARD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:DESK A-100
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-1807
Mailing Address - Fax:216-636-9422
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:DESK A-100
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-445-1807
Practice Address - Fax:216-636-9422
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13746363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health