MEDICARE: MRS. JAMIE LYNN DHILLON MSN, CNS, AGNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SA2200X	Adult Health Clinical Nurse Specialist	3170	CA
2	363LP2300X	Primary Care Nurse Practitioner	95023752	CA

General Provider Information

NPI Number	:	1417617580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE LYNN DHILLON MSN, CNS, AGNP-C

Provider Business Mailing Address
First Line	:	1544 RANCHO DEL HAMBRE
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-2316
Country	:	US
Telephone Number	:	415-816-8774
Fax Number	:

Provider Business Practice Location Address
First Line	:	1261 TRAVIS BLVD STE 320
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-4800
Country	:	US
Telephone Number	:	707-423-2506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2021
Last Update Date	:	01/14/2023

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