Provider Demographics
NPI:1619700978
Name:TRUSLOW, DYLAN LEE
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:LEE
Last Name:TRUSLOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 NICOLE DR APT E
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-2009
Mailing Address - Country:US
Mailing Address - Phone:843-472-6997
Mailing Address - Fax:
Practice Address - Street 1:101 BRANIGIN BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2598
Practice Address - Country:US
Practice Address - Phone:843-472-6997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program