Provider Demographics
NPI:1730533100
Name:DYSON, LAKETA (RN)
Entity type:Individual
Prefix:
First Name:LAKETA
Middle Name:
Last Name:DYSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9458 LANHAM SEVERN RD
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2600
Mailing Address - Country:US
Mailing Address - Phone:301-577-3000
Mailing Address - Fax:
Practice Address - Street 1:9458 LANHAM SEVERN RD
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:MD
Practice Address - Zip Code:20706-2600
Practice Address - Country:US
Practice Address - Phone:301-577-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR154296163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR154296OtherNURSING LICENSE