Provider Demographics
NPI:1871013995
Name:DILLOW, MICHELLE RENEE DANIELLE (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE DANIELLE
Last Name:DILLOW
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 K Z RATLIFF LANE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SHORE
Mailing Address - State:KY
Mailing Address - Zip Code:41175
Mailing Address - Country:US
Mailing Address - Phone:606-932-2040
Mailing Address - Fax:
Practice Address - Street 1:2801 S STAUNTON RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1222
Practice Address - Country:US
Practice Address - Phone:304-526-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021024363L00000X
KY3011646363L00000X
WV108519363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner