Provider Demographics
NPI:1003529330
Name:KING, TAWANNA Q
Entity Type:Individual
Prefix:
First Name:TAWANNA
Middle Name:Q
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18714 FORRER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2911
Mailing Address - Country:US
Mailing Address - Phone:313-694-7770
Mailing Address - Fax:
Practice Address - Street 1:18714 FORRER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2911
Practice Address - Country:US
Practice Address - Phone:313-694-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No174200000XOther Service ProvidersMeals
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide