Provider Demographics
NPI:1174295125
Name:DYKE, ANN CATHERINE (APRN)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:CATHERINE
Last Name:DYKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BEECH TREE LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-4214
Mailing Address - Country:US
Mailing Address - Phone:203-520-5572
Mailing Address - Fax:
Practice Address - Street 1:31 BEECH TREE LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-4214
Practice Address - Country:US
Practice Address - Phone:203-520-5572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily