Basic Information
| Provider Information | |||||||||
| NPI: | 1558520866 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EWAN | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | J H | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1630 N CHIPPEWA DR | ||||||||
| Address2: | |||||||||
| City: | RHINELANDER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153615480 | ||||||||
| FaxNumber: | 7153615499 | ||||||||
| Practice Location | |||||||||
| Address1: | 1630 N CHIPPEWA DR | ||||||||
| Address2: | |||||||||
| City: | RHINELANDER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153615480 | ||||||||
| FaxNumber: | 7153615499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2008 | ||||||||
| LastUpdateDate: | 12/19/2012 | ||||||||
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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 | 207Q00000X | 53343-21 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.