Basic Information
| Provider Information | |||||||||
| NPI: | 1003976895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DILLINGER | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | C.R.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 INDUSTRIAL BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PAOLI | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193011610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102510300 | ||||||||
| FaxNumber: | 6102510304 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 INDUSTRIAL BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PAOLI | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193011610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102510300 | ||||||||
| FaxNumber: | 6102510304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 11/21/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP008955 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.