Provider Demographics
NPI:1053499426
Name:DYER, NICOLE LYNN (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:DYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:325 FRONT ST # 435
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-3633
Mailing Address - Country:US
Mailing Address - Phone:307-763-7702
Mailing Address - Fax:
Practice Address - Street 1:325 FRONT ST.
Practice Address - Street 2:435
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-3633
Practice Address - Country:US
Practice Address - Phone:307-763-7702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068472A207R00000X
NH20878208M00000X
OK38700208M00000X
ND17454208M00000X
CODR.0052880208M00000X
WY8734A207R00000X
MN1614207R00000X
IDM11671207R00000X
MT18616207R00000X
CODR.0051221207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U90280Medicare UPIN
WYW24798Medicare PIN