Provider Demographics
NPI:1912154568
Name:DILDY, TRICIA DANIELLE (CRNA)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:DANIELLE
Last Name:DILDY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7407
Mailing Address - Country:US
Mailing Address - Phone:910-772-9202
Mailing Address - Fax:910-772-9452
Practice Address - Street 1:2131 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7407
Practice Address - Country:US
Practice Address - Phone:910-772-9202
Practice Address - Fax:910-772-9452
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC212707163W00000X
NC080512367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC80512OtherAANA - SC NURSING LICENSE
NC8053506Medicaid
SC19008OtherAPRN LICENSE
NCP00754275OtherRAILROAD MEDICARE
SCAN2398Medicaid
SC80512OtherAANA - SC NURSING LICENSE
NC8053506Medicaid