Provider Demographics
NPI:1063484160
Name:HYDE, DOROTHY A (PNP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:A
Last Name:HYDE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:DORY
Other - Middle Name:
Other - Last Name:HYDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:MAIL STOP 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5463
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:451 DUNLAP ST N
Practice Address - Street 2:MAIL STOP 32700A
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4621
Practice Address - Country:US
Practice Address - Phone:651-999-4700
Practice Address - Fax:651-999-4781
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0612540363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S90715Medicare UPIN