Provider Demographics
NPI:1700657368
Name:EWINGS, KIZZY TAWAN (CCHW)
Entity type:Individual
Prefix:
First Name:KIZZY
Middle Name:TAWAN
Last Name:EWINGS
Suffix:
Gender:F
Credentials:CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 GLYNN CT
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1745
Mailing Address - Country:US
Mailing Address - Phone:304-216-1200
Mailing Address - Fax:
Practice Address - Street 1:2260 GLYNN CT
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1745
Practice Address - Country:US
Practice Address - Phone:304-216-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker