Provider Demographics
NPI:1568913747
Name:DWYER, TANYA (CNP)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
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 1:265 FRANKLIN ST STE 1702
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-3144
Mailing Address - Country:US
Mailing Address - Phone:888-803-3370
Mailing Address - Fax:888-803-3331
Practice Address - Street 1:265 FRANKLIN ST STE 1702
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-3144
Practice Address - Country:US
Practice Address - Phone:888-803-3370
Practice Address - Fax:888-803-3331
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2024-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA252898363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care