Provider Demographics
NPI:1861980799
Name:DILLON, ANAMILENA
Entity type:Individual
Prefix:
First Name:ANAMILENA
Middle Name:
Last Name:DILLON
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 1:707 CEDAR ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2056
Mailing Address - Country:US
Mailing Address - Phone:574-335-4681
Mailing Address - Fax:574-335-0660
Practice Address - Street 1:707 CEDAR ST STE 100
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2056
Practice Address - Country:US
Practice Address - Phone:574-335-4681
Practice Address - Fax:574-335-0660
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28130491A163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health