Provider Demographics
NPI:1497158109
Name:DILLON, GENEVA (NP-C)
Entity Type:Individual
Prefix:
First Name:GENEVA
Middle Name:
Last Name:DILLON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-8860
Mailing Address - Fax:765-935-8859
Practice Address - Street 1:1350 CHESTER BLVD STE D
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1960
Practice Address - Country:US
Practice Address - Phone:765-935-8860
Practice Address - Fax:765-935-8859
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005224A363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201261180Medicaid
000000902809OtherANTHEM (RPA)
OH0113891Medicaid
IN259370049Medicare PIN