Basic Information
| Provider Information | |||||||||
| NPI: | 1811578198 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DWYER | ||||||||
| FirstName: | MACKENZIE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3138 MCDONALD | ||||||||
| Address2: | |||||||||
| City: | RICHLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490839343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084695205 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 JOHN ST STE N1200A | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490075341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693417979 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2021 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 4704330106 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.