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General NPI Number Information
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NPI Number | 1003529330
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Entity Type | Individual
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Provider Name | TAWANNA Q KING
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Gender | Female
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Dates
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Enumeration Date | 01/02/2023
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 18714 FORRER ST
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City | DETROIT
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State | MI
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Zip | 48235-2911
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Country | US
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Telephone | 313-694-7770
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Fax |
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Provider Business Mailing Address
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Address Line | 18714 FORRER ST
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City | DETROIT
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State | MI
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Zip | 48235-2911
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Country | US
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Telephone | 313-694-7770
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number |
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License Number State |
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