Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | NP95004184 | CA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95004184 | CA |
NPI | 1003260894 |
---|---|
Provider Name | Erin Dwyer |
First Address | San Diego, CA 92103-2116 |
Second Address | San Diego, CA 92103-2116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2016 |
Last Update Date | 18/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP95004184 | CA NP LICENSE (01) | CA |