Provider Demographics
NPI:1134306442
Name:DILLON, MAUREEN (LPN)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
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:PO BOX 621
Mailing Address - Street 2:1131 US ROUTE 9
Mailing Address - City:SCHROON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12870
Mailing Address - Country:US
Mailing Address - Phone:518-351-5019
Mailing Address - Fax:
Practice Address - Street 1:2842 PLANK ROAD
Practice Address - Street 2:
Practice Address - City:MORIAH CENTER
Practice Address - State:NY
Practice Address - Zip Code:12961
Practice Address - Country:US
Practice Address - Phone:518-546-3218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2891161164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02903175Medicaid