Provider Demographics
NPI:1447051032
Name:DILLON, MALLARIE NICOLE
Entity type:Individual
Prefix:
First Name:MALLARIE
Middle Name:NICOLE
Last Name:DILLON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1676 DALLAS DR STE C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1409
Mailing Address - Country:US
Mailing Address - Phone:225-292-5151
Mailing Address - Fax:
Practice Address - Street 1:1676 DALLAS DR STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1409
Practice Address - Country:US
Practice Address - Phone:225-292-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208207163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health