1285176453 NPI number — SHONNA LYN DILLMAN ARNP

Table of content: DR. JOHN SCHAY MD (NPI 1770604746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285176453 NPI number — SHONNA LYN DILLMAN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DILLMAN
Provider First Name:
SHONNA
Provider Middle Name:
LYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DILLMAN
Provider Other First Name:
SHONNA
Provider Other Middle Name:
LYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1285176453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3424 HIGHWAY 252 EAST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOLKSTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-496-6905
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
86567 MEADOWWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YULEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32097-6429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-424-7078
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  ARNP9248227 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)