Healthcare Provider Details

I. General information

NPI: 1366687287
Provider Name (Legal Business Name): PAMELA DAWN DWYER DNP, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA DAWN MCELVAIN WELSH

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42M MAIN ST
PITTSTON PA
18640-3103
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-602-5610
  • Fax: 570-602-5611
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP009942
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP009942
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: