Provider Demographics
NPI:1366584427
Name:DILLON, MILDRED A (RNC,OGNP)
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:A
Last Name:DILLON
Suffix:
Gender:F
Credentials:RNC,OGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8653 HIGHWAY 98 E
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39653-7347
Mailing Address - Country:US
Mailing Address - Phone:601-384-4910
Mailing Address - Fax:
Practice Address - Street 1:MILL ROAD
Practice Address - Street 2:
Practice Address - City:BUDE
Practice Address - State:MS
Practice Address - Zip Code:39630
Practice Address - Country:US
Practice Address - Phone:601-384-5871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR513474363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124009Medicaid