Provider Demographics
NPI:1558076646
Name:DEWITT, ABBIE RENAE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:RENAE
Last Name:DEWITT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2207
Mailing Address - Country:US
Mailing Address - Phone:989-772-7774
Mailing Address - Fax:
Practice Address - Street 1:709 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2207
Practice Address - Country:US
Practice Address - Phone:989-772-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704315509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily