Provider Demographics
NPI:1528014404
Name:DYER, DIANA (CNM)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DYER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 CREECH RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-4207
Mailing Address - Country:US
Mailing Address - Phone:239-262-0301
Mailing Address - Fax:239-262-7658
Practice Address - Street 1:1425 CREECH RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4207
Practice Address - Country:US
Practice Address - Phone:239-262-0301
Practice Address - Fax:239-262-7658
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9179186367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340250900Medicaid
FL340250900Medicaid
FLFA737ZMedicare PIN
FLS98185Medicare UPIN