Healthcare Provider Details

I. General information

NPI: 1376405282
Provider Name (Legal Business Name): DIANE MARIE DEWEY OWNER/COLLECTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2025
Last Update Date: 11/29/2025
Certification Date: 11/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 WATERTOWER PL STE 100-214
EAST LANSING MI
48823-8046
US

IV. Provider business mailing address

1690 WATERTOWER PL STE 100-214
EAST LANSING MI
48823-8046
US

V. Phone/Fax

Practice location:
  • Phone: 517-442-8709
  • Fax:
Mailing address:
  • Phone: 517-442-8709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: