Provider Demographics
NPI:1952658965
Name:DEWEY, DEBBIE LEE (RMA)
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:LEE
Last Name:DEWEY
Suffix:
Gender:F
Credentials:RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80572
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48908-0572
Mailing Address - Country:US
Mailing Address - Phone:517-712-4583
Mailing Address - Fax:
Practice Address - Street 1:1021 MEL AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-3619
Practice Address - Country:US
Practice Address - Phone:517-712-4583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI82449171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor