Healthcare Provider Details

I. General information

NPI: 1326017054
Provider Name (Legal Business Name): CHERYL ANN DYNES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SMITH ST
ANSONIA OH
45303-9755
US

IV. Provider business mailing address

620 SMITH ST
ANSONIA OH
45303-9755
US

V. Phone/Fax

Practice location:
  • Phone: 937-417-0817
  • Fax: 937-337-7981
Mailing address:
  • Phone: 937-417-0817
  • Fax: 937-337-7981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number294788
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: