Provider Demographics
NPI:1548932783
Name:DWYER, CAMILLE HOLDEN (FNP-C)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:HOLDEN
Last Name:DWYER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 ASHLAKE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-2827
Mailing Address - Country:US
Mailing Address - Phone:804-256-8282
Mailing Address - Fax:804-256-8288
Practice Address - Street 1:7300 ASHLAKE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-2827
Practice Address - Country:US
Practice Address - Phone:804-256-8282
Practice Address - Fax:804-256-8288
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily