Provider Demographics
NPI:1164455309
Name:DILLINGER, SUSA JANE (LMP)
Entity Type:Individual
Prefix:MS
First Name:SUSA
Middle Name:JANE
Last Name:DILLINGER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-1045
Mailing Address - Country:US
Mailing Address - Phone:360-373-3915
Mailing Address - Fax:
Practice Address - Street 1:1920 8TH ST
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1045
Practice Address - Country:US
Practice Address - Phone:360-373-3915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004860174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist