Provider Demographics
NPI:1942630363
Name:DEWEY, CARRIE L (RN)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:DEWEY
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 1:6602 N 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-3504
Mailing Address - Country:US
Mailing Address - Phone:602-435-6103
Mailing Address - Fax:
Practice Address - Street 1:6602 N 75TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85303-3504
Practice Address - Country:US
Practice Address - Phone:602-435-6103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI121470-30163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool