Basic Information
| Provider Information | |||||||||
| NPI: | 1992829881 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DYL | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R. N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 ANNANDALE RD | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028403601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016190194 | ||||||||
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| Practice Location | |||||||||
| Address1: | 65 VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028425234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018466620 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | RN33737 | RI | Y | Nursing Service Providers | Registered Nurse | Case Management |
No ID Information.