Provider Demographics
NPI:1174156657
Name:DILISIO, KURT JOHN JR (MSN, FNP-BC)
Entity type:Individual
Prefix:MR
First Name:KURT
Middle Name:JOHN
Last Name:DILISIO
Suffix:JR
Gender:M
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9471 MARKET ST STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:44452-8702
Mailing Address - Country:US
Mailing Address - Phone:330-726-7100
Mailing Address - Fax:330-758-0347
Practice Address - Street 1:9471 MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:NORTH LIMA
Practice Address - State:OH
Practice Address - Zip Code:44452-8702
Practice Address - Country:US
Practice Address - Phone:330-726-7100
Practice Address - Fax:330-758-0347
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily