Provider Demographics
NPI:1386858934
Name:DWYER, JENNIFER (CRNA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:DWYER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2 CATHARINE STREET, PO BOX 550
Mailing Address - Street 2:MID-HUDSON ANESTHESIOLOGISTS, PC
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12602
Mailing Address - Country:US
Mailing Address - Phone:866-885-2318
Mailing Address - Fax:845-790-2675
Practice Address - Street 1:70 DUBOIS STREET
Practice Address - Street 2:ST. LUKES HOSPITAL
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3550
Practice Address - Country:US
Practice Address - Phone:845-561-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY461027163W00000X
HI44236163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR9A001Medicare ID - Type Unspecified