Healthcare Provider Details

I. General information

NPI: 1972624328
Provider Name (Legal Business Name): ALISON BRIDGET DWYER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 COURT ST RM 4
PROVINCETOWN MA
02657-1322
US

IV. Provider business mailing address

PO BOX 863
PROVINCETOWN MA
02657-0863
US

V. Phone/Fax

Practice location:
  • Phone: 401-263-8735
  • Fax: 617-812-9141
Mailing address:
  • Phone: 401-263-8735
  • Fax: 617-812-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberPPNS00076
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: