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General NPI Number Information
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NPI Number | 1285011361
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Entity Type | Organization
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Legal Business Name | JEANNIE DILWORTH, LLC
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 07/27/2025
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Provider Practice Location Address
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Address Line | 642 HILLIARD ST STE 1315
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City | MANCHESTER
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State | CT
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Zip | 06042-2700
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Country | US
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Telephone | 860-335-7221
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Fax | 833-901-3911
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Provider Business Mailing Address
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Address Line | 642 HILLIARD ST STE 1315
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City | MANCHESTER
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State | CT
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Zip | 06042-2700
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Country | US
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Telephone | 860-335-6834
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Fax | 833-901-3911
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER/OWNE
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Name | JEANNIE DILWORTH
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Credential | APRN
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Telephone | 860-335-6834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 001987
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License Number State | CT
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