Provider Demographics
NPI:1346323334
Name:DWYER, MARY FLORENCE (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:FLORENCE
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 1:20930 SR 51-W
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:OH
Mailing Address - Zip Code:43430-9780
Mailing Address - Country:US
Mailing Address - Phone:419-855-7400
Mailing Address - Fax:
Practice Address - Street 1:3120 GLENDALE AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-5811
Practice Address - Country:US
Practice Address - Phone:419-383-4326
Practice Address - Fax:419-383-2847
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 242445 NP 01612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2891241Medicaid
OH2891241Medicaid