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General NPI Number Information
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NPI Number | 1104634146
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Entity Type | Individual
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Provider Name | COURTNEY LYN GWYER
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Gender | Female
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 424 SAVANNAH RD
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City | LEWES
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State | DE
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Zip | 19958-1462
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Country | US
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Telephone | 302-645-3927
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Fax |
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Provider Business Mailing Address
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Address Line | 20479 CHARLOTTE BLVD N
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City | MILLSBORO
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State | DE
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Zip | 19966-7580
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Country | US
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Telephone | 443-736-6114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 243U00000X
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Taxonomy Name | Radiology Practitioner Assistant
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License Number | 24DE1222
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License Number State | DE
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