Provider Demographics
NPI:1891023008
Name:DYER, PAMELA SUE (RN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:DYER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:SUE
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4910 ALPHA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-3214
Mailing Address - Country:US
Mailing Address - Phone:937-605-5891
Mailing Address - Fax:
Practice Address - Street 1:4910 ALPHA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-3214
Practice Address - Country:US
Practice Address - Phone:937-605-5891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-28
Last Update Date:2009-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN310732163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse