Provider Demographics
NPI:1063742682
Name:EWELIKE, CHRISTIAN C (RN)
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:C
Last Name:EWELIKE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9550 FOREST LANE
Mailing Address - Street 2:STE 310
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243
Mailing Address - Country:US
Mailing Address - Phone:214-710-7968
Mailing Address - Fax:214-553-1747
Practice Address - Street 1:9550 FOREST LANE
Practice Address - Street 2:STE 310
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:214-710-7968
Practice Address - Fax:214-553-1747
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX614002163W00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No163W00000XNursing Service ProvidersRegistered Nurse