Healthcare Provider Details

I. General information

NPI: 1326834763
Provider Name (Legal Business Name): CORRINA DILLENGER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 CLARE AVE
PORTSMOUTH OH
45662-2583
US

IV. Provider business mailing address

802 CLARE AVE
PORTSMOUTH OH
45662-2583
US

V. Phone/Fax

Practice location:
  • Phone: 408-768-4497
  • Fax: 888-966-0381
Mailing address:
  • Phone: 408-768-4497
  • Fax: 888-966-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.127035.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: