=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326834763
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CORRINA DILLENGER LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2025
-----------------------------------------------------
Last Update Date | 04/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 802 CLARE AVE
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45662-2583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-768-4497
-----------------------------------------------------
Fax | 888-966-0381
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 802 CLARE AVE
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45662-2583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-768-4497
-----------------------------------------------------
Fax | 888-966-0381
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | LPN.127035.MEDS-IV
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------