Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 05-40614 | KS |
N | 207Q00000X | Family Doctor | 2014021710 | MO |
NPI | 1003222563 |
---|---|
Provider Name | Dr. Nida Dillon |
First Address | Atlanta, GA 30374-1331 |
Second Address | Lenexa, KS 66215-2812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2014 |
Last Update Date | 10/06/2019 |