Healthcare Provider Details

I. General information

NPI: 1427344282
Provider Name (Legal Business Name): JESSICA LYNN DILLING CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LYNN GARRISON RN

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 NASON DR
ROARING SPRING PA
16673
US

IV. Provider business mailing address

105 NASON DR
ROARING SPRING PA
16673-1202
US

V. Phone/Fax

Practice location:
  • Phone: 814-224-4121
  • Fax: 814-224-6247
Mailing address:
  • Phone: 814-224-4121
  • Fax: 814-224-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP011441
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: