Healthcare Provider Details

I. General information

NPI: 1811588684
Provider Name (Legal Business Name): OLIVIA MILES DILLENBECK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CHEVES ST STE 301
FLORENCE SC
29506-2615
US

IV. Provider business mailing address

401 E CHEVES ST STE 301
FLORENCE SC
29506-2615
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-7166
  • Fax: 843-777-7167
Mailing address:
  • Phone: 843-777-7166
  • Fax: 843-777-7167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMPA.3848
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: