Provider Demographics
NPI:1104205509
Name:DILLON, JACQUELINE BARBARA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:BARBARA
Last Name:DILLON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 TILDEN ST
Mailing Address - Street 2:APT. 5J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6028
Mailing Address - Country:US
Mailing Address - Phone:718-207-7741
Mailing Address - Fax:
Practice Address - Street 1:836 TILDEN ST
Practice Address - Street 2:APT. 5J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6028
Practice Address - Country:US
Practice Address - Phone:718-207-7741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321530-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse