Healthcare Provider Details

I. General information

NPI: 1629267695
Provider Name (Legal Business Name): DEBRA M. WOJNO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA SWISZ

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 BIDDLE ST
WYANDOTTE MI
48192-4668
US

IV. Provider business mailing address

2333 BIDDLE ST
WYANDOTTE MI
48192-4668
US

V. Phone/Fax

Practice location:
  • Phone: 734-246-6909
  • Fax:
Mailing address:
  • Phone: 734-246-6909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number711941
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: