Basic Information
| Provider Information | |||||||||
| NPI: | 1437472016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MC EWAN | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | RN, MSN,FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 TECHNOLOGY DR | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926182302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499233277 | ||||||||
| FaxNumber: | 8558125865 | ||||||||
| Practice Location | |||||||||
| Address1: | 1198 PACIFIC COAST HWY | ||||||||
| Address2: | SUITE I | ||||||||
| City: | SEAL BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907406251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627997071 | ||||||||
| FaxNumber: | 5625945627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2010 | ||||||||
| LastUpdateDate: | 09/13/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | NP19528 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.