Individual
MR. DUSTIN DE'WAYNE SHEETS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PRESIDENT-CEO / IDE
Contact information
Practice address
1020 HOSBROOK ST, SUITE D, INDIANAPOLIS, IN 46203-1067
(317) 646-8105
Mailing address
1020 HOSBROOK ST, SUITE D, INDIANAPOLIS, IN 46203-1067
(317) 646-8105
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
0480-12-5874
IN
374700000X
Technician
QMA1400100
IN
374U00000X
Home Health Aide
HHA1204113
IN
376K00000X
Nurse's Aide
CNA0605779
IN
Other
Enumeration date
06/24/2015
Last updated
07/22/2015
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