Healthcare Provider Details

I. General information

NPI: 1659811305
Provider Name (Legal Business Name): DOROTHY OWINO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9081 WAYNE RD APT B17
LIVONIA MI
48150-3697
US

IV. Provider business mailing address

9081 WAYNE RD APT B17
LIVONIA MI
48150-3697
US

V. Phone/Fax

Practice location:
  • Phone: 313-333-2067
  • Fax:
Mailing address:
  • Phone: 313-333-2067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704290613
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: