Provider Demographics
NPI:1033526264
Name:DEWALT, NAOMI MARIE
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:MARIE
Last Name:DEWALT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1587 WATERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WALDO
Mailing Address - State:ME
Mailing Address - Zip Code:04915-3222
Mailing Address - Country:US
Mailing Address - Phone:207-322-4077
Mailing Address - Fax:
Practice Address - Street 1:1587 WATERVILLE RD
Practice Address - Street 2:
Practice Address - City:WALDO
Practice Address - State:ME
Practice Address - Zip Code:04915-3222
Practice Address - Country:US
Practice Address - Phone:207-322-4077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide