Provider Demographics
NPI:1396882668
Name:DILLMAN, AUDREY DIANE (OM)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:DIANE
Last Name:DILLMAN
Suffix:
Gender:F
Credentials:OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 BRIARCREST DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3175
Mailing Address - Country:US
Mailing Address - Phone:817-291-8462
Mailing Address - Fax:
Practice Address - Street 1:204 S. MAIN STR
Practice Address - Street 2:SUITE 225
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248
Practice Address - Country:US
Practice Address - Phone:817-319-5477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist