Provider Demographics
NPI:1811665565
Name:DILLON, NIMIA
Entity type:Individual
Prefix:
First Name:NIMIA
Middle Name:
Last Name:DILLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 MOBLEY RD
Mailing Address - Street 2:
Mailing Address - City:PATRIOT
Mailing Address - State:OH
Mailing Address - Zip Code:45658-9357
Mailing Address - Country:US
Mailing Address - Phone:740-339-0989
Mailing Address - Fax:
Practice Address - Street 1:1565 MOBLEY RD
Practice Address - Street 2:
Practice Address - City:PATRIOT
Practice Address - State:OH
Practice Address - Zip Code:45658-9357
Practice Address - Country:US
Practice Address - Phone:740-339-0989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0434057Medicaid