Provider Demographics
NPI:1851964571
Name:DILLARD, SUZETTE DENNIS (NP)
Entity type:Individual
Prefix:
First Name:SUZETTE
Middle Name:DENNIS
Last Name:DILLARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:PAGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29728-1925
Mailing Address - Country:US
Mailing Address - Phone:704-289-9605
Mailing Address - Fax:
Practice Address - Street 1:126 N PEARL ST
Practice Address - Street 2:
Practice Address - City:PAGELAND
Practice Address - State:SC
Practice Address - Zip Code:29728-1925
Practice Address - Country:US
Practice Address - Phone:438-675-5004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014207363LG0600X, 363LP2300X, 363LA2100X, 363LA2200X
SCAPN28139RX363LP2300X
NCAPN28139RX363L00000X
SCAPN28138RX363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health