Individual
MARI I DEBOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
123 N PINE ST, SAINT LOUIS, MI 48880-1428
(989) 721-0857
Mailing address
123 N PINE ST, SAINT LOUIS, MI 48880-1428
(989) 721-0857
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
1934415
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1934415
EMERGENCY MEDICAL TECHNICIAN LICENSE
MI
Enumeration date
06/18/2019
Last updated
06/18/2019
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