Provider Demographics
NPI:1952727638
Name:DYER, DEIDRE (RN)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:DYER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DEIDRE
Other - Middle Name:
Other - Last Name:RIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 BERWICK RD N
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-3305
Mailing Address - Country:US
Mailing Address - Phone:315-395-7429
Mailing Address - Fax:
Practice Address - Street 1:200 BERWICK RD N
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-3305
Practice Address - Country:US
Practice Address - Phone:315-395-7429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH628521163WH0200X
NY628521163WX0200X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WX0200XNursing Service ProvidersRegistered NurseOncology