Provider Demographics
NPI:1942533732
Name:DYER, EDWARD D (LPN)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:D
Last Name:DYER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 FORD HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKSHIRE
Mailing Address - State:NY
Mailing Address - Zip Code:13736-2136
Mailing Address - Country:US
Mailing Address - Phone:607-657-8130
Mailing Address - Fax:
Practice Address - Street 1:466 FORD HILL RD
Practice Address - Street 2:
Practice Address - City:BERKSHIRE
Practice Address - State:NY
Practice Address - Zip Code:13736-2136
Practice Address - Country:US
Practice Address - Phone:607-657-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286952164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse