Provider Demographics
NPI:1477984128
Name:VANALSTINE, DAWN
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:VANALSTINE
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 1:6104 W PIERSON RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-3129
Mailing Address - Country:US
Mailing Address - Phone:810-600-2211
Mailing Address - Fax:810-820-4567
Practice Address - Street 1:6104 W PIERSON RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-3129
Practice Address - Country:US
Practice Address - Phone:810-600-2211
Practice Address - Fax:810-820-4567
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICTR2409260335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier