Individual
LEATRICE KIICHELLE DYER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
23 BRITTANY CT, NORTHPORT, NY 11768-3225
(631) 374-0977
Mailing address
282 W 15TH ST, DEER PARK, NY 11729-6304
(631) 374-0974
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
338518
NY
Other
Enumeration date
07/01/2020
Last updated
07/01/2020
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