Provider Demographics
NPI:1003026667
Name:DWYER, MAUREEN LOUISE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:LOUISE
Last Name:DWYER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7251
Mailing Address - Country:US
Mailing Address - Phone:802-860-7030
Mailing Address - Fax:
Practice Address - Street 1:MCCLURE 5 FLETCHERALLEN HEALTHCARE
Practice Address - Street 2:111COLCHESTER AVE
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1429
Practice Address - Country:US
Practice Address - Phone:802-847-2804
Practice Address - Fax:802-847-2806
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010010339363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0NP1099Medicaid
VTNP1099Medicare ID - Type Unspecified
VT0NP1099Medicaid