Provider Demographics
NPI:1861897647
Name:DYER, KAREN MARIE (RN,CCM)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:DYER
Suffix:
Gender:F
Credentials:RN,CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 PUGHES CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-5473
Mailing Address - Country:US
Mailing Address - Phone:678-491-1085
Mailing Address - Fax:770-710-0653
Practice Address - Street 1:1219 PUGHES CREEK WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-5473
Practice Address - Country:US
Practice Address - Phone:678-491-1085
Practice Address - Fax:770-710-0653
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN215362163W00000X, 163WC0400X, 163WH0200X, 163WN1003X, 163WP0807X, 163WP0809X, 163WR0400X, 163WX0106X
MO061092163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health