MEDICARE: MRS. LAUREN ASHLEY DILLON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	00897	WV

General Provider Information

NPI Number	:	1225099633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN ASHLEY DILLON PA-C

Provider Business Mailing Address
First Line	:	84 BROOKSHIRE LN
Second Line	:
City	:	BECKLEY
State	:	WV
Zip	:	25801-6765
Country	:	US
Telephone Number	:	304-255-2341
Fax Number	:	304-255-2343

Provider Business Practice Location Address
First Line	:	84 BROOKSHIRE LN
Second Line	:
City	:	BECKLEY
State	:	WV
Zip	:	25801-6765
Country	:	US
Telephone Number	:	304-255-2341
Fax Number	:	304-255-2343

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	07/11/2014

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