Provider Demographics
NPI:1750497061
Name:DALLMIER, SHIRLEY (PA)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:DALLMIER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3307 BROADWAY ST STE 140
Mailing Address - Street 2:CARE FIRST MEDICAL CENTER
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2387
Mailing Address - Country:US
Mailing Address - Phone:618-244-7200
Mailing Address - Fax:618-244-7274
Practice Address - Street 1:3307 BROADWAY ST STE 130
Practice Address - Street 2:PHYSICIAN RURAL HEALTH CLINIC OF JEFFERSON COUNTY
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2387
Practice Address - Country:US
Practice Address - Phone:618-244-7200
Practice Address - Fax:618-244-7274
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085-000622363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL77015Medicare PIN