MEDICARE: CHANELLE ARDELL DILLARD LPN

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	164W00000X	Licensed Practical Nurse	140340	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932413218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANELLE ARDELL DILLARD LPN

Provider Business Mailing Address
First Line	:	3685 PARKER KNOLL LN
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-6210
Country	:	US
Telephone Number	:	614-439-6017
Fax Number	:

Provider Business Practice Location Address
First Line	:	3685 PARKER KNOLL LN
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-6210
Country	:	US
Telephone Number	:	614-439-6017
Fax Number	:

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

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	01/26/2015

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