Provider Demographics
NPI:1184850562
Name:DWYER, RUTH ELLEN (FNP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ELLEN
Last Name:DWYER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1557
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-0557
Mailing Address - Country:US
Mailing Address - Phone:765-342-8383
Mailing Address - Fax:
Practice Address - Street 1:1949 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1861
Practice Address - Country:US
Practice Address - Phone:765-342-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-31
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28124397A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200971330Medicaid
ININ1232002Medicare PIN