Provider Demographics
NPI:1447877212
Name:HILL, KEWANNA LENISE
Entity type:Individual
Prefix:
First Name:KEWANNA
Middle Name:LENISE
Last Name:HILL
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 1:33006 7 MILE RD # 129
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1358
Mailing Address - Country:US
Mailing Address - Phone:313-629-8023
Mailing Address - Fax:
Practice Address - Street 1:20533 POINCIANA
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1201
Practice Address - Country:US
Practice Address - Phone:313-629-8023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-28
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist