Provider Demographics
NPI:1902227366
Name:DINN, MAE
Entity Type:Individual
Prefix:
First Name:MAE
Middle Name:
Last Name:DINN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7766 EWING BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-7537
Mailing Address - Country:US
Mailing Address - Phone:859-283-1033
Mailing Address - Fax:859-283-1066
Practice Address - Street 1:7766 EWING BLVD
Practice Address - Street 2:STE 100
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-7537
Practice Address - Country:US
Practice Address - Phone:859-283-1033
Practice Address - Fax:859-283-1066
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1830363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPA1830OtherKENTUCKY BOARD OF MEDICAL LICENSURE