Healthcare Provider Details

I. General information

NPI: 1699210435
Provider Name (Legal Business Name): NAOMI DYSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7055 SAMUEL MORSE DR #200
COLUMBIA MD
21046-3439
US

IV. Provider business mailing address

7055 SAMUEL MORSE DR #200
COLUMBIA MD
21046-3439
US

V. Phone/Fax

Practice location:
  • Phone: 410-910-6700
  • Fax:
Mailing address:
  • Phone: 410-910-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR167369
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: