MEDICARE: DENISE MARIE DYE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	335921	NY

General Provider Information

NPI Number	:	1205063120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE MARIE DYE FNP

Provider Business Mailing Address
First Line	:	11 NORTH STREET
Second Line	:	EDMESTON HEATLHZONE
City	:	EDMESTON
State	:	NY
Zip	:	13335-3014
Country	:	US
Telephone Number	:	607-965-6930
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 NORTH STREET
Second Line	:	EDMESTON HEATLHZONE
City	:	EDMESTON
State	:	NY
Zip	:	13335-3014
Country	:	US
Telephone Number	:	607-965-6930
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2009
Last Update Date	:	07/14/2009

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