Healthcare Provider Details

I. General information

NPI: 1487640686
Provider Name (Legal Business Name): JUDY LYNN DYE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6973 LINDA VISTA RD
SAN DIEGO CA
92111-6339
US

IV. Provider business mailing address

4580 47TH ST
SAN DIEGO CA
92115-3207
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-0925
  • Fax:
Mailing address:
  • Phone: 619-640-3066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN 345111
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License NumberRN345111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: