Provider Demographics
NPI:1356167407
Name:DYER, MICHELLE RENE (LPN)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:RENE
Last Name:DYER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:RENE
Other - Last Name:DOBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:755 BRAVES AVE UNIT 1447
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-3343
Mailing Address - Country:US
Mailing Address - Phone:678-557-3887
Mailing Address - Fax:
Practice Address - Street 1:755 BRAVES AVE UNIT 1447
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-3343
Practice Address - Country:US
Practice Address - Phone:678-557-3887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN060140164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse