Individual
SHAWNA DAVELLA DIETRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
35675 GARNER ST, ROMULUS, MI 48174-4129
(810) 308-7991
Mailing address
PO BOX 74083, ROMULUS, MI 48174-0083
(810) 308-7991
Taxonomy
Speciality
Code
Description
License number
State
385HR2065X
Child Physical Disabilities Respite Care
Primary
D362765135841
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D362765135841
IDENTIFICATION
MI
Enumeration date
02/27/2020
Last updated
02/27/2020
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