Provider Demographics
NPI:1063176451
Name:DEWEY, MICHELLE RENAY
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENAY
Last Name:DEWEY
Suffix:
Gender:F
Credentials:
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 23
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:OH
Mailing Address - Zip Code:43515-0023
Mailing Address - Country:US
Mailing Address - Phone:567-868-5560
Mailing Address - Fax:
Practice Address - Street 1:9360 COUNTY ROAD 10
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:OH
Practice Address - Zip Code:43515-9288
Practice Address - Country:US
Practice Address - Phone:567-868-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant