Provider Demographics
NPI:1578840559
Name:DYSON, BREH N (RN)
Entity type:Individual
Prefix:
First Name:BREH
Middle Name:N
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 1:880 THIERIOT AVE
Mailing Address - Street 2:APT 3A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2821
Mailing Address - Country:US
Mailing Address - Phone:718-617-2002
Mailing Address - Fax:
Practice Address - Street 1:880 THIERIOT AVE
Practice Address - Street 2:APT 3A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2821
Practice Address - Country:US
Practice Address - Phone:718-617-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY618318163W00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management