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General NPI Number Information
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NPI Number | 1720449440
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Entity Type | Individual
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Provider Name | STACIE LYNN DEWITT
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Gender | Female
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 460 NANTUCKET PL APT M
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City | VERMILION
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State | OH
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Zip | 44089-3281
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Country | US
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Telephone | 440-989-6420
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 391
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City | VERMILION
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State | OH
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Zip | 44089-0391
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Country | US
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Telephone | 440-989-6420
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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