Provider Demographics
NPI:1811588684
Name:DILLENBECK, OLIVIA MILES (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:MILES
Last Name:DILLENBECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:103 GREGG AVE NW
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3096
Mailing Address - Country:US
Mailing Address - Phone:803-226-9786
Mailing Address - Fax:803-226-0839
Practice Address - Street 1:103 GREGG AVE NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3096
Practice Address - Country:US
Practice Address - Phone:803-226-9786
Practice Address - Fax:803-563-8614
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCMPA.3848363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant