Provider Demographics
NPI:1275096810
Name:DWYER, ROSE MCCLURE (APRN, CNP)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:MCCLURE
Last Name:DWYER
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 2140
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3143
Mailing Address - Country:US
Mailing Address - Phone:312-695-3800
Mailing Address - Fax:312-695-3644
Practice Address - Street 1:676 N SAINT CLAIR ST STE 2140
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3143
Practice Address - Country:US
Practice Address - Phone:312-695-3800
Practice Address - Fax:312-695-3644
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019161204F00000X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily