Provider Demographics
NPI:1346082369
Name:DILLON, REBECCA SUE (LPN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:DILLON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:S
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:8214 CLEAR FORK RD
Mailing Address - Street 2:
Mailing Address - City:DOROTHY
Mailing Address - State:WV
Mailing Address - Zip Code:25060-9678
Mailing Address - Country:US
Mailing Address - Phone:304-854-1544
Mailing Address - Fax:
Practice Address - Street 1:8214 CLEAR FORK RD
Practice Address - Street 2:
Practice Address - City:DOROTHY
Practice Address - State:WV
Practice Address - Zip Code:25060-9678
Practice Address - Country:US
Practice Address - Phone:304-854-1544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV34026164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty