Provider Demographics
NPI:1902946064
Name:DWYER, MARYPAT BLUM (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MARYPAT
Middle Name:BLUM
Last Name:DWYER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:PATRICIA
Other - Last Name:BLUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:508 W. 31ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601
Mailing Address - Country:US
Mailing Address - Phone:785-218-5077
Mailing Address - Fax:785-628-4089
Practice Address - Street 1:3314 SW FRONT ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1952
Practice Address - Country:US
Practice Address - Phone:785-221-2915
Practice Address - Fax:785-354-9541
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45960363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily