Provider Demographics
NPI:1336147321
Name:TALBOO-DILLON, NATALIE LIZETTE (PA)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:LIZETTE
Last Name:TALBOO-DILLON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE
Mailing Address - Street 2:STE 800
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:330-673-6988
Mailing Address - Fax:
Practice Address - Street 1:2121 HUGHES DR STE 310
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3845
Practice Address - Country:US
Practice Address - Phone:419-291-3858
Practice Address - Fax:419-480-8701
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001437363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068270Medicaid
OH96512Medicare UPIN