Provider Demographics
NPI:1497077242
Name:DEWING, TINA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:DEWING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 SOUTHWIND DR
Mailing Address - Street 2:#208
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4756
Mailing Address - Country:US
Mailing Address - Phone:262-325-8383
Mailing Address - Fax:
Practice Address - Street 1:625 SOUTHWIND DR
Practice Address - Street 2:#208
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4756
Practice Address - Country:US
Practice Address - Phone:262-325-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI166915030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health