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General NPI Number Information
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NPI Number | 1982187100
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Entity Type | Individual
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Provider Name | THERESA ANN DWYER
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Gender | Female
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Dates
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Enumeration Date | 09/13/2018
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Last Update Date | 11/23/2019
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Provider Practice Location Address
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Address Line | 2335 E KASHIAN LN STE 240
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City | FRESNO
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State | CA
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Zip | 93701-2211
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Country | US
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Telephone | 559-320-0545
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Fax | 559-320-0550
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Provider Business Mailing Address
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Address Line | 1700 E 19TH ST
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City | THE DALLES
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State | OR
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Zip | 97058-3317
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Country | US
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Telephone | 559-443-2682
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Fax | 559-443-2681
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA55969
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA55969
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License Number State | CA
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