Provider Demographics
NPI:1205464989
Name:DYER, AMBER DENISE (LVN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DENISE
Last Name:DYER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 AUSTIN CORNERS ST
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-9726
Mailing Address - Country:US
Mailing Address - Phone:903-386-5909
Mailing Address - Fax:
Practice Address - Street 1:11 AUSTIN CORNERS ST
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-9726
Practice Address - Country:US
Practice Address - Phone:903-386-5909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309873164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse