Provider Demographics
NPI:1831120187
Name:DWYER, LINDA HOLSOMBACK (MSN APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:HOLSOMBACK
Last Name:DWYER
Suffix:
Gender:F
Credentials:MSN APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-1906
Mailing Address - Country:US
Mailing Address - Phone:423-265-2455
Mailing Address - Fax:423-266-3426
Practice Address - Street 1:551 OAK ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1906
Practice Address - Country:US
Practice Address - Phone:423-265-2455
Practice Address - Fax:423-266-3426
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN31299364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0193911OtherBCBS PROVIDER ID