Active NPI
Jacqueline Dwyer, RD, CDE
- Registered Dietitian
- Phila, PA
National Provider Identifier
1629201462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DNOO1179
- Practice address
- 211 S 9TH St
Suite 600
Phila, PA 19107-6810 - Phone
- (215) 955-0453
- NPI assigned
- Aug 27, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DNOO1179 | PA | Primary |
Addresses
Primary practice location
211 S 9TH St
Suite 600
Phila, PA 19107-6810
Mailing address
1179 Cleveland Rd
Blue Bell, PA 19422-1807
Phone (484) 919-7480
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DNOO1179 | PA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347926400000",
"number": "1629201462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1179 CLEVELAND RD",
"city": "BLUE BELL",
"state": "PA",
"postal_code": "194221807",
"telephone_number": "484-919-7480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 S 9TH ST",
"address_2": "SUITE 600",
"city": "PHILA",
"state": "PA",
"postal_code": "191076810",
"telephone_number": "215-955-0453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DWYER",
"first_name": "JACQUELINE",
"name_prefix": "Ms.",
"credential": "RD, CDE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-27",
"last_updated": "2012-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "PA",
"license": "DNOO1179",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phila, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.