Provider Demographics
NPI:1558191155
Name:DIPERNA, TILLIE MARIE
Entity type:Individual
Prefix:
First Name:TILLIE
Middle Name:MARIE
Last Name:DIPERNA
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 1:378 DIPERNA RD
Mailing Address - Street 2:
Mailing Address - City:SHINNSTON
Mailing Address - State:WV
Mailing Address - Zip Code:26431-6910
Mailing Address - Country:US
Mailing Address - Phone:304-592-3928
Mailing Address - Fax:
Practice Address - Street 1:378 DIPERNA RD
Practice Address - Street 2:
Practice Address - City:SHINNSTON
Practice Address - State:WV
Practice Address - Zip Code:26431-6910
Practice Address - Country:US
Practice Address - Phone:304-592-3928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant