Provider Demographics
NPI:1497059224
Name:PHENIX-STOLL, DAWN JO
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:JO
Last Name:PHENIX-STOLL
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 1:5771 S DERBY RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:MI
Mailing Address - Zip Code:48884-9364
Mailing Address - Country:US
Mailing Address - Phone:989-328-6041
Mailing Address - Fax:989-831-5009
Practice Address - Street 1:312 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888
Practice Address - Country:US
Practice Address - Phone:989-831-5000
Practice Address - Fax:989-831-5009
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care