Provider Demographics
NPI:1427225598
Name:DYE, MARIE L (LPN)
Entity Type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:L
Last Name:DYE
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 1:6562 N 107TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-5022
Mailing Address - Country:US
Mailing Address - Phone:414-358-2278
Mailing Address - Fax:414-760-0388
Practice Address - Street 1:6562 N 107TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-5022
Practice Address - Country:US
Practice Address - Phone:414-358-2278
Practice Address - Fax:414-760-0388
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33318-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35034800Medicare PIN