Provider Demographics
NPI:1629507926
Name:LARRY-DILLARD, JEANETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:
Last Name:LARRY-DILLARD
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 1:1050 KLONDYKE RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-9658
Mailing Address - Country:US
Mailing Address - Phone:513-313-4575
Mailing Address - Fax:
Practice Address - Street 1:791 E MCMILLAN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1910
Practice Address - Country:US
Practice Address - Phone:513-235-5286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN094729163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health