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General NPI Number Information
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NPI Number | 1821051061
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Entity Type | Individual
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Provider Name | RENEE ANNE DWYER MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1 LAKE ST BLDG D
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City | NEW BRITAIN
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State | CT
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Zip | 06052-1396
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Country | US
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Telephone | 860-348-4820
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Fax | 860-348-4931
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Provider Business Mailing Address
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Address Line | 214 CEDAR HOLLOW DR
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City | ROCKY HILL
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State | CT
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Zip | 06067-2643
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 000239
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 228444
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License Number State | CT
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