Provider Demographics
NPI:1306019005
Name:DILLEY, ROSA M (RN)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:M
Last Name:DILLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19872 STATE HIGHWAY 131
Mailing Address - Street 2:
Mailing Address - City:GAYS MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:54631-7233
Mailing Address - Country:US
Mailing Address - Phone:608-735-4993
Mailing Address - Fax:
Practice Address - Street 1:19872 STATE HIGHWAY 131
Practice Address - Street 2:
Practice Address - City:GAYS MILLS
Practice Address - State:WI
Practice Address - Zip Code:54631-7233
Practice Address - Country:US
Practice Address - Phone:608-735-4993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice