Provider Demographics
NPI:1053902486
Name:DILLON, TAMARUA JEAN
Entity type:Individual
Prefix:MISS
First Name:TAMARUA
Middle Name:JEAN
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 1:2337 EDGEMONT RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-4748
Mailing Address - Country:US
Mailing Address - Phone:740-646-9753
Mailing Address - Fax:
Practice Address - Street 1:2337 EDGEMONT RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-4748
Practice Address - Country:US
Practice Address - Phone:740-646-9752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant