Healthcare Provider Details

I. General information

NPI: 1316376106
Provider Name (Legal Business Name): SHERECE DYER HILL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 HARRY S TRUMAN DR N
LARGO MD
20774-5477
US

IV. Provider business mailing address

901 HARRY S TRUMAN DR N
LARGO MD
20774-5477
US

V. Phone/Fax

Practice location:
  • Phone: 240-677-3000
  • Fax:
Mailing address:
  • Phone: 240-677-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number249742
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number104379048
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN1051899
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: