Provider Demographics
NPI:1346528098
Name:EWING, KRISTIN JOY (RN)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JOY
Last Name:EWING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:JOY
Other - Last Name:FREDERICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:152 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:PA
Mailing Address - Zip Code:19475-1803
Mailing Address - Country:US
Mailing Address - Phone:484-374-3634
Mailing Address - Fax:610-792-3652
Practice Address - Street 1:152 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:PA
Practice Address - Zip Code:19475-1803
Practice Address - Country:US
Practice Address - Phone:484-374-3634
Practice Address - Fax:610-792-3652
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN574997163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse