Healthcare Provider Details

I. General information

NPI: 1861081366
Provider Name (Legal Business Name): CHRISTINE DYSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4977 NORTHCUTT PL
DAYTON OH
45414-3839
US

IV. Provider business mailing address

4977 NORTHCUTT PL
DAYTON OH
45414-3839
US

V. Phone/Fax

Practice location:
  • Phone: 373-876-3959
  • Fax:
Mailing address:
  • Phone: 937-387-6395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number415636
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: