Provider Demographics
NPI:1477059319
Name:DWYER-MARTIN, MELANIE (LPN)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:DWYER-MARTIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CLOVER RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-1423
Mailing Address - Country:US
Mailing Address - Phone:315-243-6792
Mailing Address - Fax:
Practice Address - Street 1:415 CLOVER RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-1423
Practice Address - Country:US
Practice Address - Phone:315-214-4911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-31
Last Update Date:2018-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129040-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse