Provider Demographics
NPI:1205170206
Name:DYER, BERMESOLA M (APRN)
Entity type:Individual
Prefix:DR
First Name:BERMESOLA
Middle Name:M
Last Name:DYER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-7101
Mailing Address - Country:US
Mailing Address - Phone:202-505-5207
Mailing Address - Fax:
Practice Address - Street 1:413 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-7101
Practice Address - Country:US
Practice Address - Phone:202-505-5207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003221363LF0000X
MDR158722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily