Healthcare Provider Details

I. General information

NPI: 1750482584
Provider Name (Legal Business Name): MARY F. DWYER PCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 JOHN A CUMMINGS WAY
WOONSOCKET RI
02895-3247
US

IV. Provider business mailing address

83 ROSEGARDEN ST
WARWICK RI
02888-2812
US

V. Phone/Fax

Practice location:
  • Phone: 401-235-7000
  • Fax:
Mailing address:
  • Phone: 401-467-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberPPNS00004
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN00359
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: