Healthcare Provider Details

I. General information

NPI: 1639519572
Provider Name (Legal Business Name): ELAINE DAWN DUBE LLBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15644 SKANEE RD
LANSE MI
49946-9003
US

IV. Provider business mailing address

29795 KIILUNEN RD
CALUMET MI
49913-9110
US

V. Phone/Fax

Practice location:
  • Phone: 906-524-5885
  • Fax:
Mailing address:
  • Phone: 906-369-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6802087449
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: