Provider Demographics
NPI:1558414292
Name:DWYER, DEBORAH A (CRNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:DWYER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 IRVING ST NW
Mailing Address - Street 2:2700N
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2927
Mailing Address - Country:US
Mailing Address - Phone:202-723-5524
Mailing Address - Fax:202-291-0512
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:2700N
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-723-5524
Practice Address - Fax:202-291-0512
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0147534363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC013267C29Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
DCQ07620Medicare UPIN