Provider Demographics
NPI:1194109959
Name:EWINGS, CARESSA
Entity type:Individual
Prefix:
First Name:CARESSA
Middle Name:
Last Name:EWINGS
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 1:2413 BRADY COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6885
Mailing Address - Country:US
Mailing Address - Phone:614-376-7253
Mailing Address - Fax:
Practice Address - Street 1:2413 BRADY COMMONS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6885
Practice Address - Country:US
Practice Address - Phone:614-376-7253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-11
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH159126164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse