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General NPI Number Information
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NPI Number | 1437782075
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Entity Type | Individual
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Provider Name | MRS. SHARON LYNN DEWEY
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Gender | Female
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 1425 ZIGGY RD.
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City | FARWELL
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State | MI
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Zip | 48622
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Country | US
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Telephone | 989-588-4264
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Fax |
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Provider Business Mailing Address
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Address Line | 1425 ZIGGY RD.
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City | FARWELL
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State | MI
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Zip | 48622
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Country | US
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Telephone | 989-588-4264
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | AF180001483
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License Number State | MI
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