Provider Demographics
NPI:1972990943
Name:DEWITT, MAUREEN NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:NICOLE
Last Name:DEWITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:NICOLE
Other - Last Name:GIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2680 VULCAN ST
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-2344
Mailing Address - Country:US
Mailing Address - Phone:231-777-2732
Mailing Address - Fax:231-773-8979
Practice Address - Street 1:684 HARVEY ST STE 201
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-4274
Practice Address - Country:US
Practice Address - Phone:231-777-2732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301108083208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics