Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1523 | AR |
NPI | 1023023702 |
---|---|
Provider Name | Ms. Lori A Dryer |
First Address | Jonesboro, AR 72403-6656 |
Second Address | Jonesboro, AR 72401-7237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 25/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11424218 | CAQH (01) | AR |
4659187 | CIGNA (01) | AR |
5U434 | BCBS (01) | AR |
7591057 | AETNA (01) | AR |
U76807 | (02) | AR |