Healthcare Provider Details

I. General information

NPI: 1942282504
Provider Name (Legal Business Name): ELIZABETH GRACE DYER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 TIOGUE AVE
COVENTRY RI
02816-6116
US

IV. Provider business mailing address

106 NATE WHIPPLE HWY STE 101
CUMBERLAND RI
02864-1403
US

V. Phone/Fax

Practice location:
  • Phone: 401-821-6800
  • Fax: 401-821-8513
Mailing address:
  • Phone: 401-739-7380
  • Fax: 401-658-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP37099
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN01326
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: