Provider Demographics
NPI:1497858732
Name:DILLON, LAURA J (NP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
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 1:200 FLEETWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-2022
Mailing Address - Country:US
Mailing Address - Phone:864-442-8278
Mailing Address - Fax:864-442-7339
Practice Address - Street 1:925 S LONG DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4835
Practice Address - Country:US
Practice Address - Phone:910-417-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA169332363L00000X
NC5010219363L00000X
SC1328363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA584870656ABMedicaid
SCNP1066Medicaid
SCP456869342Medicare PIN
GA584870656ABMedicaid