MEDICARE: GENEVA DILLON NP-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	363LG0600X	Gerontology Nurse Practitioner	71005224A	IN
2	363LA2200X	Adult Health Nurse Practitioner	71005224A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000902809	OTHER	ANTHEM (RPA)
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497158109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENEVA DILLON NP-C

Provider Business Mailing Address
First Line	:	1100 REID PKWY
Second Line	:	MEDICAL STAFF SERVICES
City	:	RICHMOND
State	:	IN
Zip	:	47374-1157
Country	:	US
Telephone Number	:	765-935-8860
Fax Number	:	765-935-8859

Provider Business Practice Location Address
First Line	:	1350 CHESTER BLVD STE D
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1960
Country	:	US
Telephone Number	:	765-935-8860
Fax Number	:	765-935-8859

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

Provider Enumeration Date	:	10/08/2014
Last Update Date	:	05/13/2021

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Directions to “ GENEVA DILLON NP-C” Practice Location

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