Provider Demographics
NPI:1457360174
Name:DILLON, MARIE C (FNP)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:C
Last Name:DILLON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 PAPPAS ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-1705
Mailing Address - Country:US
Mailing Address - Phone:956-718-6259
Mailing Address - Fax:956-718-6294
Practice Address - Street 1:1515 PAPPAS ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-1705
Practice Address - Country:US
Practice Address - Phone:956-718-6259
Practice Address - Fax:956-718-6294
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX606362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606362OtherLICENSE
TX181606801Medicaid
TX606362OtherLICENSE