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General NPI Number Information
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NPI Number | 1679161640
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Entity Type | Individual
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Provider Name | ISABEL NAOMI DETWILER
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Gender | Female
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Dates
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Enumeration Date | 01/06/2021
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 677 E MAIN ST
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City | CENTREVILLE
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State | MI
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Zip | 49032-8524
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Country | US
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Telephone | 269-467-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 58058 MARLENE DR
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City | THREE RIVERS
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State | MI
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Zip | 49093-9346
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Country | US
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Telephone | 269-262-2400
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6802090857
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6852090857
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6851115926
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License Number State | MI
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