Provider Demographics
NPI:1952328486
Name:DYER, GERRI (NP)
Entity Type:Individual
Prefix:
First Name:GERRI
Middle Name:
Last Name:DYER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N PARK AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3150
Mailing Address - Country:US
Mailing Address - Phone:618-942-3344
Mailing Address - Fax:618-942-5045
Practice Address - Street 1:220 N PARK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3150
Practice Address - Country:US
Practice Address - Phone:618-942-3344
Practice Address - Fax:618-942-5045
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCB3700OtherRAILROAD GROUP NUMBER
ILK07911OtherUMWA PROVIDER NUMBER
ILK16716OtherUMWA PROVIDER NUMBER
ILP00103464OtherRAILROAD PROVIDER NUMBER
ILK07911Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
ILQ19752Medicare UPIN
IL209424Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IL211499Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ILK16716OtherUMWA PROVIDER NUMBER