Healthcare Provider Details

I. General information

NPI: 1124161039
Provider Name (Legal Business Name): DENISE DWYER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 SCHOOL ST
MANCHESTER MA
01944-1700
US

IV. Provider business mailing address

4 STRONG ST
NEWBURYPORT MA
01950-2411
US

V. Phone/Fax

Practice location:
  • Phone: 978-526-4311
  • Fax: 978-525-2342
Mailing address:
  • Phone: 978-526-4311
  • Fax: 978-525-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number181833
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: