Healthcare Provider Details

I. General information

NPI: 1396339107
Provider Name (Legal Business Name): ELIZABETH M DYER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S WHITE HORSE PIKE
HAMMONTON NJ
08037-2014
US

IV. Provider business mailing address

112 JANET ST
VINELAND NJ
08360-9616
US

V. Phone/Fax

Practice location:
  • Phone: 609-270-4260
  • Fax:
Mailing address:
  • Phone: 609-364-4937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01099400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: