Provider Demographics
NPI:1255044004
Name:DEWBRE, JOHNIE RUTH (BACHELOR OF SCIENCE)
Entity type:Individual
Prefix:MRS
First Name:JOHNIE
Middle Name:RUTH
Last Name:DEWBRE
Suffix:
Gender:F
Credentials:BACHELOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 SE 136TH RD
Mailing Address - Street 2:
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-7678
Mailing Address - Country:US
Mailing Address - Phone:918-448-7701
Mailing Address - Fax:
Practice Address - Street 1:103 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-4043
Practice Address - Country:US
Practice Address - Phone:918-465-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator