Individual
STACIE LYNN DEWITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
460 NANTUCKET PL, APT M, VERMILION, OH 44089-3281
(440) 989-6420
Mailing address
PO BOX 391, VERMILION, OH 44089-0391
(440) 989-6420
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
376K00000X
Nurse's Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102938217-00
—
OH
Enumeration date
03/08/2016
Last updated
03/08/2016
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