Provider Demographics
NPI:1962190959
Name:DEWIT, CAROL ANN (LPN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:DEWIT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:MADDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 SW 31ST TER
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-1181
Mailing Address - Country:US
Mailing Address - Phone:918-350-4545
Mailing Address - Fax:
Practice Address - Street 1:4901 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-4945
Practice Address - Country:US
Practice Address - Phone:405-605-4005
Practice Address - Fax:405-601-2023
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL-64988164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse