Provider Demographics
NPI:1184647877
Name:DWYER, KATHLEEN MARIE (RD, LDN, PHD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:DWYER
Suffix:
Gender:F
Credentials:RD, LDN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 SOCIETY PARK CT APT D
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4932
Mailing Address - Country:US
Mailing Address - Phone:717-652-1848
Mailing Address - Fax:
Practice Address - Street 1:4204 SOCIETY PARK CT APT D
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4932
Practice Address - Country:US
Practice Address - Phone:717-652-1848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001241133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered