Provider Demographics
NPI:1598033656
Name:DWYER, DENICE B, (RNC-E)
Entity Type:Individual
Prefix:MS
First Name:DENICE
Middle Name:B,
Last Name:DWYER
Suffix:
Gender:F
Credentials:RNC-E
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FAIRWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3349
Mailing Address - Country:US
Mailing Address - Phone:860-918-4079
Mailing Address - Fax:
Practice Address - Street 1:1250 SILVER ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3946
Practice Address - Country:US
Practice Address - Phone:860-346-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE42590163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse