Individual
MARY ELLEN DWYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CRNA
Contact information
Practice address
111 FOUNDERS PLZ, #300 C/O IPMS, EAST HARTFORD, CT 06108-3212
(860) 282-4137
(860) 282-0170
Mailing address
300 GEORGE ST, FL 6, NEW HAVEN, CT 06511-6624
(860) 282-4137
(860) 282-0170
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
001361
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004231221
—
CT
Enumeration date
03/22/2006
Last updated
05/13/2016
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