Healthcare Provider Details

I. General information

NPI: 1891023008
Provider Name (Legal Business Name): PAMELA SUE DYER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA SUE WATKINS

II. Dates (important events)

Enumeration Date: 11/28/2009
Last Update Date: 11/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 ALPHA RD
SPRINGFIELD OH
45504-3214
US

IV. Provider business mailing address

4910 ALPHA RD
SPRINGFIELD OH
45504-3214
US

V. Phone/Fax

Practice location:
  • Phone: 937-605-5891
  • Fax:
Mailing address:
  • Phone: 937-605-5891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN310732
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: