Darice Diane Dwyer, PHN

Key facts

NPI

1265766752

Entity type

Individual (NPI type 1)

Primary specialty

Home Health Registered Nurse 163WH0200X

License

R091398-0 (MN)

Practice address

616 America Ave NW
Suite #130
Bemidji, MN 56601-3818

Phone

(218) 333-8152

Fax

(218) 333-8160

NPI assigned

Sep 30, 2009

Sex

Female

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• County of Beltrami State or Local Public Health Clinic/Center · Bemidji, MN · NPI 1043281876
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 30, 2009.

{
    "created_epoch": "1254268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254268800000",
    "number": "1265766752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 AMERICA AVE NW",
            "address_2": "SUITE #130",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566013818",
            "telephone_number": "218-333-8152",
            "fax_number": "218-333-8160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 AMERICA AVE NW",
            "address_2": "SUITE #130",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566013818",
            "telephone_number": "218-333-8152",
            "fax_number": "218-333-8160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DWYER",
        "first_name": "DARICE",
        "middle_name": "DIANE",
        "credential": "PHN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-30",
        "last_updated": "2009-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "MN",
            "license": "R091398-0",
            "primary": false
        },
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "MN",
            "license": "R091398-0",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8231BE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIME WEST",
            "identifier": "567553700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Bemidji, MN · Home Health Registered Nurse in Minnesota