Provider Demographics
NPI:1659811305
Name:OWINO, DOROTHY (NP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:OWINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9081 WAYNE RD APT B17
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3697
Mailing Address - Country:US
Mailing Address - Phone:313-333-2067
Mailing Address - Fax:
Practice Address - Street 1:9081 WAYNE RD APT B17
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3697
Practice Address - Country:US
Practice Address - Phone:313-333-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704290613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily