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General NPI Number Information
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NPI Number | 1225784093
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Entity Type | Individual
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Provider Name | KIMBERLY LAUREN DYE
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Gender | Female
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Dates
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Enumeration Date | 03/01/2022
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 7640 SYLVANIA AVE STE F
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City | SYLVANIA
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State | OH
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Zip | 43560-9263
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Country | US
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Telephone | 855-565-8346
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Fax |
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Provider Business Mailing Address
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Address Line | 3156 DUSTIN RD STE 100
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City | OREGON
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State | OH
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Zip | 43616-4300
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Country | US
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Telephone | 855-565-8346
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704276085
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN.CNP.0029679
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License Number State | OH
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