Basic Information
| Provider Information | |||||||||
| NPI: | 1548977481 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DWYER | ||||||||
| FirstName: | ARIEL | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RBT | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1060 WIGWAM PKWY | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890748162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025476971 | ||||||||
| FaxNumber: | 7025476948 | ||||||||
| Practice Location | |||||||||
| Address1: | 3950 LAS VEGAS BLVD N # A2 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891150598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025476971 | ||||||||
| FaxNumber: | 7025476948 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2022 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-22 | NV | Y |
ID Information
| ID | Type | State | Issuer | Description | RBT-22 | 01 | NV | BACB | OTHER |