Provider Demographics
NPI:1235466228
Name:DYER, MYRTLELYN CYNTHIA (LPN)
Entity Type:Individual
Prefix:MS
First Name:MYRTLELYN
Middle Name:CYNTHIA
Last Name:DYER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 PENFIELD ST
Mailing Address - Street 2:APT. 1C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1332
Mailing Address - Country:US
Mailing Address - Phone:347-346-5579
Mailing Address - Fax:
Practice Address - Street 1:834 PENFIELD ST
Practice Address - Street 2:APT. 1C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1332
Practice Address - Country:US
Practice Address - Phone:347-346-5579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265145-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMD6553Other265145-1