Healthcare Provider Details

I. General information

NPI: 1407933955
Provider Name (Legal Business Name): KATHRYN ANN DWYER RN,C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 VALLEY RD
MIDDLETOWN RI
02842-5234
US

IV. Provider business mailing address

10 BEACH AVE
NEWPORT RI
02840-3615
US

V. Phone/Fax

Practice location:
  • Phone: 401-846-6620
  • Fax:
Mailing address:
  • Phone: 401-846-6620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN33453
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: