Provider Demographics
NPI:1225789662
Name:DILLNER, JADA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:MARIE
Last Name:DILLNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11640 NORTHPARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5741
Mailing Address - Country:US
Mailing Address - Phone:919-436-4124
Mailing Address - Fax:
Practice Address - Street 1:11640 NORTHPARK DR STE 200
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5741
Practice Address - Country:US
Practice Address - Phone:919-436-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 363A00000X
NC0010-12516363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program