Provider Demographics
NPI:1306811146
Name:DYER, TERESA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:DYER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10155 YORK RD
Mailing Address - Street 2:STE 200
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3352
Mailing Address - Country:US
Mailing Address - Phone:410-628-2026
Mailing Address - Fax:410-667-6834
Practice Address - Street 1:10155 YORK RD
Practice Address - Street 2:STE 200
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3352
Practice Address - Country:US
Practice Address - Phone:410-628-2026
Practice Address - Fax:410-667-6834
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR076951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD98414Medicare UPIN