MEDICARE: CARRIE L DEWEY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	121470-30	WI

General Provider Information

NPI Number	:	1942630363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE L DEWEY RN

Provider Business Mailing Address
First Line	:	6602 N 75TH AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-3504
Country	:	US
Telephone Number	:	602-435-6103
Fax Number	:

Provider Business Practice Location Address
First Line	:	6602 N 75TH AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-3504
Country	:	US
Telephone Number	:	602-435-6103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2013
Last Update Date	:	11/21/2013

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