Provider Demographics
NPI:1528562246
Name:DYER, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:DYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 S HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-9310
Mailing Address - Country:US
Mailing Address - Phone:918-708-3006
Mailing Address - Fax:918-999-0109
Practice Address - Street 1:2109 S HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-9310
Practice Address - Country:US
Practice Address - Phone:918-708-3006
Practice Address - Fax:918-999-0109
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator