Provider Demographics
NPI:1477188761
Name:EWELL, ERICA (CCMA, CMT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:EWELL
Suffix:
Gender:F
Credentials:CCMA, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 N ANVIL LN
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-4269
Mailing Address - Country:US
Mailing Address - Phone:301-630-0869
Mailing Address - Fax:
Practice Address - Street 1:2054 N ANVIL LN
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-4269
Practice Address - Country:US
Practice Address - Phone:301-630-0869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMT0111214247200000X
DCY2K3N2W9251J00000X
MDL18207613251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No251J00000XAgenciesNursing Care