Provider Demographics
NPI:1477332807
Name:DILLARD, ANGELA ZANNETTA (N/A)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ZANNETTA
Last Name:DILLARD
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 WYTHE PKWY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23661-2926
Mailing Address - Country:US
Mailing Address - Phone:757-907-2756
Mailing Address - Fax:
Practice Address - Street 1:216 WYTHE PKWY
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23661-2926
Practice Address - Country:US
Practice Address - Phone:757-907-2756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel