Healthcare Provider Details

I. General information

NPI: 1821508722
Provider Name (Legal Business Name): ROSE MARIE CECILE DYER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4217 NW 37TH TERRACE
LAUDERDALE LAKES FL
33309
US

IV. Provider business mailing address

4217 NW 37TH TER
LAUDERDALE LAKES FL
33309-4149
US

V. Phone/Fax

Practice location:
  • Phone: 305-879-1828
  • Fax:
Mailing address:
  • Phone: 305-879-1828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number5243436
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: