Healthcare Provider Details

I. General information

NPI: 1902998115
Provider Name (Legal Business Name): MICHELE LEE DYER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/25/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10650 PARK RD STE 480
CHARLOTTE NC
28210-8538
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 704-667-0520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5002210
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5002210
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: