Provider Demographics
NPI:1669639803
Name:DEWITT, CAZZIE L (RN)
Entity Type:Individual
Prefix:MISS
First Name:CAZZIE
Middle Name:L
Last Name:DEWITT
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 1:865 BROADWAY AVE
Mailing Address - Street 2:APT215B
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4953
Mailing Address - Country:US
Mailing Address - Phone:516-852-6839
Mailing Address - Fax:
Practice Address - Street 1:865 BROADWAY AVE
Practice Address - Street 2:APT215B
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4953
Practice Address - Country:US
Practice Address - Phone:516-852-6839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY580560163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health