Provider Demographics
NPI:1881318798
Name:EWING, TISA E
Entity type:Individual
Prefix:MRS
First Name:TISA
Middle Name:E
Last Name:EWING
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 1:22 YELLOW CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-3114
Mailing Address - Country:US
Mailing Address - Phone:330-506-1771
Mailing Address - Fax:
Practice Address - Street 1:22 YELLOW CREEK CIR
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-3114
Practice Address - Country:US
Practice Address - Phone:330-506-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4935123253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4935123OtherSTATE OF OHIO