Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | CNP6756 | MN |
NPI | 1003468760 |
---|---|
Provider Name | Molly B Dwyer |
First Address | Fargo, ND 58103-4940 |
Second Address | Duluth, MN 55805-1951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2019 |
Last Update Date | 07/08/2019 |