Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | AP30004827 | WA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP30004827 | WA |
NPI | 1538117650 |
---|---|
Provider Name | Jolie Ewart |
First Address | Spokane, WA 99218-1257 |
Second Address | Spokane, WA 99218-1257 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 13/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9623240 | (05) | WA |
S91194 | (02) | WA |