Doctor Name: | MS. BERMESOLA M DYER |
NPI Number: | 1205170206 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | R158722 |
Business Practice Address: | 2003 Davidsonville Rd Crofton, MD - 21114 |
Business Phone Number: | 4432269882 |
Business Fax Number: | |
Mailing Address: | 3559 Floating Leaf Ln Apt E302, LAUREL |
State: | MD |
Postal Code: | 207244908 |
Phone Number: | 4432269882 |
Fax Number: | |
NPI Enumeration Date: | 11/15/2012 |
NPI Last Update Date: | 11/15/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R158722 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |