Provider Demographics
NPI:1548973654
Name:DIMM, NATASHIA
Entity type:Individual
Prefix:
First Name:NATASHIA
Middle Name:
Last Name:DIMM
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 1:4932 OLD CAPITOL TRL
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5212
Mailing Address - Country:US
Mailing Address - Phone:443-350-3767
Mailing Address - Fax:
Practice Address - Street 1:4932 OLD CAPITOL TRL
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5212
Practice Address - Country:US
Practice Address - Phone:443-350-3767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0035189163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management