Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | CNP 4440 | MN |
NPI | 1023479458 |
---|---|
Provider Name | Allison Dillon |
First Address | Edina, MN 55435-2133 |
Second Address | Edina, MN 55435-2133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2016 |
Last Update Date | 12/03/2016 |