Individual
KILLEEN DWYER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16 MCGRATH LN, LEBANON, CT 06249-2606
(860) 884-9074
Mailing address
16 MCGRATH LN, LEBANON, CT 06249-2606
(860) 884-9074
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
93660
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
93660
LICENSE
CT
Enumeration date
06/06/2022
Last updated
06/06/2022
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