MEDICARE: HAILEY DYER LVN

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	164X00000X	Licensed Vocational Nurse	345148	TX

General Provider Information

NPI Number	:	1649882283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY DYER LVN

Provider Business Mailing Address
First Line	:	989 AN COUNTY ROAD 383
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75801-7168
Country	:	US
Telephone Number	:	903-724-6861
Fax Number	:

Provider Business Practice Location Address
First Line	:	989 AN COUNTY ROAD 383
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75801-7168
Country	:	US
Telephone Number	:	903-724-6861
Fax Number	:

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

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	08/17/2020

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Directions to “ HAILEY DYER LVN” Practice Location

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