Provider Demographics
NPI:1053562025
Name:DILLARD, THERESA YVONNE (RN)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:YVONNE
Last Name:DILLARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:YVONNE
Other - Last Name:DDILLARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:302 BROOKS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-2431
Mailing Address - Country:US
Mailing Address - Phone:585-319-4256
Mailing Address - Fax:
Practice Address - Street 1:302 BROOKS AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-2431
Practice Address - Country:US
Practice Address - Phone:585-319-4256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY607597-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse