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General NPI Number Information
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NPI Number | 1659031714
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Entity Type | Individual
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Provider Name | TONYA LATRECE EWELL RN
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Gender | Female
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Dates
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Enumeration Date | 12/29/2021
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 30 HUNTER LN
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City | CAMP HILL
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State | PA
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Zip | 17011-2400
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Country | US
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Telephone | 800-748-3243
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Fax |
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Provider Business Mailing Address
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Address Line | 1410 WILLSHIRE DR
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City | ABERDEEN
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State | MD
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Zip | 21001-4023
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Country | US
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Telephone | 443-226-0759
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704381617
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License Number State | MI
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