MEDICARE: JANE DEWEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1174938666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE DEWEY

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	ST STEPHENS
State	:	WY
Zip	:	82524-0190
Country	:	US
Telephone Number	:	307-856-0470
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 GREAT PLAINS RD
Second Line	:
City	:	ARAPAHO
State	:	WY
Zip	:	82510
Country	:	US
Telephone Number	:	307-856-0470
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	06/24/2014

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