Healthcare Provider Details

I. General information

NPI: 1528014404
Provider Name (Legal Business Name): DIANA DYER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 CREECH RD
NAPLES FL
34103-4207
US

IV. Provider business mailing address

1425 CREECH RD
NAPLES FL
34103-4207
US

V. Phone/Fax

Practice location:
  • Phone: 239-262-0301
  • Fax: 239-262-7658
Mailing address:
  • Phone: 239-262-0301
  • Fax: 239-262-7658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP9179186
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: