Individual
ELIZABETH IRENE DEWYSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.R/L
Contact information
Practice address
694 E KITCHEN RD, PINCONNING, MI 48650-7486
(989) 879-4867
Mailing address
694 E KITCHEN RD, PINCONNING, MI 48650-7486
(989) 879-4867
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
3549529
MI
Other
Enumeration date
06/16/2014
Last updated
06/16/2014
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