Provider Demographics
NPI:1972858561
Name:DILLON, ANNULET A (RN)
Entity Type:Individual
Prefix:
First Name:ANNULET
Middle Name:A
Last Name:DILLON
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 1:6100 OLD BRANDON RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2543
Mailing Address - Country:US
Mailing Address - Phone:601-260-4605
Mailing Address - Fax:601-933-1113
Practice Address - Street 1:6100 OLD BRANDON RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2543
Practice Address - Country:US
Practice Address - Phone:601-260-4605
Practice Address - Fax:601-933-1113
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR883305163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse