Provider Demographics
NPI:1194154187
Name:DWYER, MELISSA MAE (CNP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MAE
Last Name:DWYER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 643398
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-3398
Mailing Address - Country:US
Mailing Address - Phone:513-221-1100
Mailing Address - Fax:513-569-5697
Practice Address - Street 1:9075 CENTRE POINTE DR STE 200
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4886
Practice Address - Country:US
Practice Address - Phone:513-221-1100
Practice Address - Fax:513-569-5312
Is Sole Proprietor?:No
Enumeration Date:2013-11-11
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.15310363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH941510OtherWELLCARE
OH0095085Medicaid
OHP01311254OtherRAILROAD MEDICARE
OH000000868233OtherANTHEM
OH0095085Medicaid