Healthcare Provider Details

I. General information

NPI: 1760472773
Provider Name (Legal Business Name): MINDA JOY DWYER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MINDA JOY HUBBARD NP

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 HACKETT BLVD
ALBANY NY
12209-1750
US

IV. Provider business mailing address

66 HACKETT BLVD
ALBANY NY
12209-1750
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-4439
  • Fax: 518-262-8460
Mailing address:
  • Phone: 518-262-4439
  • Fax: 518-262-8460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number302093
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: