Provider Demographics
NPI:1760179493
Name:DYER, ASHLEY DANIELLE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DANIELLE
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 1:1955 31ST RD
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:KS
Mailing Address - Zip Code:67546-8618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1955 31ST RD
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:KS
Practice Address - Zip Code:67546-8618
Practice Address - Country:US
Practice Address - Phone:620-474-7908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS52926164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse