Provider Demographics
NPI:1629668397
Name:DWYER, EMILY RENEE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:RENEE
Last Name:DWYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3358 COUNTY ROAD 10
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-8648
Mailing Address - Country:US
Mailing Address - Phone:419-551-9583
Mailing Address - Fax:
Practice Address - Street 1:936 E WILSON ST APT F2
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1863
Practice Address - Country:US
Practice Address - Phone:419-212-6056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health