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General NPI Number Information
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NPI Number | 1639196397
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Entity Type | Organization
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Legal Business Name | MARYE DILLON PSC
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | 2103 STRATHMOOR BLVD
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City | LOUISVILLE
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State | KY
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Zip | 40205-2529
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Country | US
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Telephone | 502-836-9025
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Fax | 502-458-1337
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Provider Business Mailing Address
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Address Line | 2103 STRATHMOOR BLVD
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City | LOUISVILLE
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State | KY
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Zip | 40205-2529
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Country | US
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Telephone | 502-836-9025
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Fax | 502-458-1337
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARYE B DILLON
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Credential | ARNP
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Telephone | 502-836-9025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3990
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License Number State | KY
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