Provider Demographics
NPI:1710225834
Name:DILISIO, DOLORAS ROSE (RN)
Entity Type:Individual
Prefix:
First Name:DOLORAS
Middle Name:ROSE
Last Name:DILISIO
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 1:2872 FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9079
Mailing Address - Country:US
Mailing Address - Phone:330-598-0609
Mailing Address - Fax:
Practice Address - Street 1:2872 FRANKLIN DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9079
Practice Address - Country:US
Practice Address - Phone:330-598-0609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-221617163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health