Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 4893-33 | WI |
NPI | 1003162462 |
---|---|
Provider Name | Leslie Ewens |
First Address | Eau Claire, WI 54703-6335 |
Second Address | Eau Claire, WI 54703-6335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2012 |
Last Update Date | 02/08/2012 |