Provider Demographics
NPI:1710224233
Name:DILL, SHARYL M (LP00012610)
Entity type:Individual
Prefix:MRS
First Name:SHARYL
Middle Name:M
Last Name:DILL
Suffix:
Gender:F
Credentials:LP00012610
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 CHASE AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3974
Mailing Address - Country:US
Mailing Address - Phone:509-626-1909
Mailing Address - Fax:505-270-3048
Practice Address - Street 1:906 CHASE AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3974
Practice Address - Country:US
Practice Address - Phone:509-626-1909
Practice Address - Fax:505-270-3048
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00012610164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse