Healthcare Provider Details

I. General information

NPI: 1114479805
Provider Name (Legal Business Name): MICHELLE DWYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE SHAFFER R.N.

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 SAVANNAH RD
LEWES DE
19958-1462
US

IV. Provider business mailing address

902 GALLATIN CT
MIDDLETOWN DE
19709-9277
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-3300
  • Fax:
Mailing address:
  • Phone: 302-750-7785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberL1-0030789
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: