Provider Demographics
NPI:1295539740
Name:DILLON, STELLA MARIE
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:MARIE
Last Name:DILLON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:MARIE
Other - Last Name:LICKLITER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4237 N 87TH TER
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-3142
Mailing Address - Country:US
Mailing Address - Phone:402-604-5428
Mailing Address - Fax:
Practice Address - Street 1:1820 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3636
Practice Address - Country:US
Practice Address - Phone:402-682-6599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant