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NPI Code Detail

MEDICARE: JENNIFER DEAN DWYER PA

MEDICARE: JENNIFER DEAN DWYER PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant8809MN

General Provider Information

NPI Number : 1770551475
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER DEAN DWYER PA
Provider Business Mailing Address
First Line : 21555 FIRESIDE CT
Second Line :
City : COLD SPRING
State : MN
Zip : 56320-8704
Country : US
Telephone Number : 320-685-7091
Fax Number :
Provider Business Practice Location Address
First Line : 200 W 1ST ST
Second Line :
City : PAYNESVILLE
State : MN
Zip : 56362-1445
Country : US
Telephone Number : 320-243-3779
Fax Number : 320-243-6707
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2006
Last Update Date : 07/08/2007

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Directions to “ JENNIFER DEAN DWYER PA” Practice Location

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