Individual
MR. WIDMARK ROY DWYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
22 UNICORN CT, PALM COAST, FL 32164-5760
(561) 692-1925
Mailing address
22 UNICORN CT, PALM COAST, FL 32164-5760
(561) 692-1925
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
T520553726280
FL
Other
Enumeration date
12/13/2016
Last updated
12/13/2016
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