Provider Demographics
NPI:1366039174
Name:DILLISTONE, CARRI D
Entity Type:Individual
Prefix:
First Name:CARRI
Middle Name:D
Last Name:DILLISTONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 US ROUTE 60 W
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-1133
Mailing Address - Country:US
Mailing Address - Phone:304-654-8370
Mailing Address - Fax:
Practice Address - Street 1:1707 US ROUTE 60 W
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541-1133
Practice Address - Country:US
Practice Address - Phone:304-654-8370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant