Healthcare Provider Details

I. General information

NPI: 1972868719
Provider Name (Legal Business Name): CARA M DILLINGER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N WALNUT ST
BERNIE MO
63822-8901
US

IV. Provider business mailing address

810 N WALNUT ST
BERNIE MO
63822-8901
US

V. Phone/Fax

Practice location:
  • Phone: 573-293-5336
  • Fax: 573-293-5338
Mailing address:
  • Phone: 573-293-5336
  • Fax: 573-293-5338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012019345
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: