Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1010010339 | VT |
NPI | 1003026667 |
---|---|
Provider Name | Ms. Maureen Louise Dwyer |
First Address | South Burlington, VT 05403-7251 |
Second Address | Burlington, VT 05401-1429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0NP1099 | (05) | VT |
S55890 | (02) | VT |