Provider Demographics
NPI:1215442546
Name:DEWITT, SHAWNA (CPM)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:DEWITT
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11661 HARPERS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-1944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3620 BUCKEYSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:BUCKEYSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21717-1001
Practice Address - Country:US
Practice Address - Phone:240-341-4974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000129176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife