Provider Demographics
NPI:1619862877
Name:DILLON, DAVID AUSTIN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:AUSTIN
Last Name:DILLON
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 CALLE CASCABELA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-5903
Mailing Address - Country:US
Mailing Address - Phone:336-449-0456
Mailing Address - Fax:
Practice Address - Street 1:1227 N RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3147
Practice Address - Country:US
Practice Address - Phone:505-384-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM54744163W00000X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)