Provider Demographics
NPI:1467454132
Name:DWYER, LESANN L (CNM)
Entity Type:Individual
Prefix:MS
First Name:LESANN
Middle Name:L
Last Name:DWYER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 E ALTAMONTE DR
Mailing Address - Street 2:SUITE 318
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5105
Mailing Address - Country:US
Mailing Address - Phone:407-303-5204
Mailing Address - Fax:407-303-5205
Practice Address - Street 1:661 E ALTAMONTE DR
Practice Address - Street 2:SUITE 318
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5105
Practice Address - Country:US
Practice Address - Phone:407-303-5204
Practice Address - Fax:407-303-5205
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3419072207V00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340121900Medicaid
FL340121900Medicaid
FLE8070WMedicare PIN