Individual
DARICE DIANE DWYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHN
Contact information
Practice address
616 AMERICA AVE NW, SUITE #130, BEMIDJI, MN 56601-3818
(218) 333-8152
(218) 333-8160
Mailing address
616 AMERICA AVE NW, SUITE #130, BEMIDJI, MN 56601-3818
(218) 333-8152
(218) 333-8160
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
R091398-0
MN
163WH0200X
Home Health Registered Nurse
Primary
R091398-0
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
567553700
PRIME WEST
MN
01
—
8231BE
BLUE CROSS BLUE SHIELD
MN
Enumeration date
09/30/2009
Last updated
09/30/2009
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