NPIMap

Individual provider Active NPI

Nicole M Dwyer, PA

  • Physician Assistant
  • Lewiston, ID
National Provider Identifier
1780860908
Registry record updated May 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-1980 Issued in ID
Practice address
415 6TH Street
Lewiston, ID 83501-2434
Phone
(208) 750-7507
NPI assigned
Jan 17, 2008
Last updated
May 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Medical Physician Assistant 363AM0700X PA-1980 ID
Physician Assistant 363A00000X PA-1980 ID Primary

Addresses

Primary practice location

415 6TH Street
Lewiston, ID 83501-2434

Mailing address

415 6TH Street
Lewiston, ID 83501-2434
Phone (208) 750-7507

Other practice location 1

2500 W A St Ste 101
Moscow, ID 83843-6000
Phone (208) 882-0540

Other names 1

  • Ms. Nicole M Dwyer Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100107000390 WA Practitioner - Physician Assistant 0840331245 Reassigns benefits to 3 organizations
I20210210001626 ID Practitioner - Physician Assistant 0840331245 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sterling Provider GroupGroup PAC ID 2264773373, 52 clinicians
St Joseph Hospital LLCGroup PAC ID 8325325806, 91 clinicians

Practice addresses (Care Compare)

200 Nat Washington Way
Ephrata, WA 98823-1982

200 Nat Washington Way
Columbia Basin Hospital
Ephrata, WA 98823-1997
Phone (509) 754-4631

220 Nat Washington Way
Ephrata, WA 98823-1982

2201 Thain Grade
Lewiston, ID 83501-4118
Phone (208) 717-3100

415 6TH St
Lewiston, ID 83501-2431

740 S Woodruff Ave
Idaho Falls, ID 83401-5285
Phone 20854291111026

821 21St Ave
Lewiston, ID 83501-6389
Phone (208) 799-3422

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA-1980IDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Joseph Hospital LLC CurrentSince Feb 1, 2025 Accepting new patients
Grant Co Public Hospital District 3 CurrentSince Aug 1, 2025 Accepting new patients
Gritman Medical Center, Inc. Current Accepting new patients
Urgent Care Associates PLLC Current Accepting new patients
Gritman Medical Center Inc CurrentSince Jan 1, 2025 Accepting new patients
Grant County Public Hospital District No. 3 CurrentSince Aug 1, 2025 Accepting new patients
Gritman Medical Center Inc. CurrentSince Jan 1, 2025 Accepting new patients
Tri-State Memorial Hospital CurrentSince Aug 1, 2020 Accepting new patients
Sterling Provider Group CurrentSince Jul 19, 2023 Accepting new patients
St. Joseph Hospital LLC Past Accepting new patients
Grant County Public Hospital District No. 3 Past Accepting new patients

Locations

10965 W Overland Rd
Boise, ID 83709
Phone (208) 900-9901

1129 S Broadway Ave
Boise, ID 83706
Phone (208) 795-9790

6965 N Glenwood St
Boise, ID 83714
Phone (208) 853-3000

1404 Pomerelle Ave
Ste A1
Burley, ID 83318
Phone (208) 878-8783

5605 Northside Xing
Chubbuck, ID 83202
Phone (208) 547-5062

507 S Main St
Hailey, ID 83333
Phone (208) 788-0061

7017 Daisy Ln
Idaho Falls, ID 83402
Phone (208) 534-5878

740 S Woodruff Ave
Idaho Falls, ID 83401
Phone (208) 542-9111

2201 Thain Grade
Lewiston, ID 83501
Phone (208) 717-3100

415 6th St
Lewiston, ID 83501
Phone (208) 750-7445

821 21st Ave
Lewiston, ID 83501
Phone (208) 799-3422

3185 E Ustick Rd
Meridian, ID 83646
Phone (208) 296-7100

2500 W A St
Ste 101
Moscow, ID 83843
Phone (208) 882-0540

623 S Main St
Ste 1
Moscow, ID 83843
Phone (208) 882-2011

700 S Main St
Moscow, ID 83843
Phone (208) 746-7555

1610 Caldwell Blvd
Nampa, ID 83651
Phone (208) 207-8500

130 W Main St
Rexburg, ID 83440
Phone (208) 356-8818

1221 Highland Ave
Clarkston, WA 99403
Phone (509) 751-0312

200 Nat Washington Way
Ephrata, WA 98823
Phone (509) 754-3330

220 Nat Washington Way
Ephrata, WA 98823
Phone (509) 754-3330

835 SE Bishop Blvd
Pullman, WA 99163
Phone (509) 332-2541

Interoperability endpoints

  • Direct secure messaging: nicole.dwyer.1@16883.direct.athenahealth.com

Organizations & group practices 14

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

View all 14

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748476800000",
    "number": "1780860908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 6TH STREET",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012434",
            "telephone_number": "208-750-7507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 6TH STREET",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012434",
            "telephone_number": "208-750-7507"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 W A St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Moscow",
            "state": "ID",
            "postal_code": "838436000",
            "country_code": "US",
            "telephone_number": "208-882-0540",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DWYER",
        "first_name": "NICOLE",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-17",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-1980",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "DWYER",
            "middle_name": "M",
            "prefix": "MS.",
            "credential": "MPAS, PA-C, LMP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Lewiston, ID

Sources for this page

Verify at the official NPI Registry.