MEDICARE: KYLEE JEAN DWYER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN2286478	MA

General Provider Information

NPI Number	:	1184571812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLEE JEAN DWYER

Provider Business Mailing Address
First Line	:	130 FOREST ST
Second Line	:
City	:	STONEHAM
State	:	MA
Zip	:	02180-3223
Country	:	US
Telephone Number	:	781-249-8853
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 MAIN ST STE 306
Second Line	:
City	:	WINCHESTER
State	:	MA
Zip	:	01890-4303
Country	:	US
Telephone Number	:	781-938-1888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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Directions to “ KYLEE JEAN DWYER ” Practice Location

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