Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 7254 | NE |
NPI | 1033524640 |
---|---|
Provider Name | Dr. Jennifer Dwyer |
First Address | Omaha, NE 68132-1837 |
Second Address | Omaha, NE 68198-4110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2014 |
Last Update Date | 25/07/2015 |