Healthcare Provider Details

I. General information

NPI: 1275800195
Provider Name (Legal Business Name): JOAN M DWYER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 SPACKENKILL RD
POUGHKEEPSIE NY
12603-5040
US

IV. Provider business mailing address

112 SPACKENKILL RD
POUGHKEEPSIE NY
12603-5040
US

V. Phone/Fax

Practice location:
  • Phone: 846-463-2043
  • Fax: 845-463-7826
Mailing address:
  • Phone: 846-463-2043
  • Fax: 845-463-7826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number5277761
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: