Provider Demographics
NPI:1871982454
Name:DWYER, LORELEI HIPOLITO (AGPCNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LORELEI
Middle Name:HIPOLITO
Last Name:DWYER
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6207
Mailing Address - Country:US
Mailing Address - Phone:781-489-5541
Mailing Address - Fax:781-489-4340
Practice Address - Street 1:378 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-6207
Practice Address - Country:US
Practice Address - Phone:781-489-5541
Practice Address - Fax:781-489-4340
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN193013363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care