Provider Demographics
NPI:1902621204
Name:SIMPSON, TAWANNA (CHW)
Entity type:Individual
Prefix:
First Name:TAWANNA
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 ATKINSON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-2005
Mailing Address - Country:US
Mailing Address - Phone:313-422-3617
Mailing Address - Fax:
Practice Address - Street 1:1500 ATKINSON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2005
Practice Address - Country:US
Practice Address - Phone:313-422-3617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI119342525172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker