Provider Demographics
NPI:1558520866
Name:EWAN, AMY J H (DO)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J H
Last Name:EWAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1630 N CHIPPEWA DR
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501
Mailing Address - Country:US
Mailing Address - Phone:715-361-5480
Mailing Address - Fax:715-361-5499
Practice Address - Street 1:1630 N CHIPPEWA DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501
Practice Address - Country:US
Practice Address - Phone:715-361-5480
Practice Address - Fax:715-361-5499
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI53343-21207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine