Provider Demographics
NPI:1225853054
Name:EWANG, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:EWANG
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 1:800 BUFFALO CT
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-3912
Mailing Address - Country:US
Mailing Address - Phone:256-585-4222
Mailing Address - Fax:
Practice Address - Street 1:800 BUFFALO CT
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-3912
Practice Address - Country:US
Practice Address - Phone:256-585-4222
Practice Address - Fax:817-549-2986
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No376J00000XNursing Service Related ProvidersHomemaker