Provider Demographics
NPI:1831063817
Name:KITWANO, RUKIYA
Entity type:Individual
Prefix:MS
First Name:RUKIYA
Middle Name:
Last Name:KITWANO
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 1:13101 FREUD ST APT 224
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-3258
Mailing Address - Country:US
Mailing Address - Phone:313-341-1821
Mailing Address - Fax:
Practice Address - Street 1:13101 FREUD ST APT 224
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-3258
Practice Address - Country:US
Practice Address - Phone:313-341-1821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator