Provider Demographics
NPI:1093087249
Name:EWAN, LISA M (APN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:EWAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 N BROAD ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-4635
Mailing Address - Country:US
Mailing Address - Phone:856-251-0500
Mailing Address - Fax:
Practice Address - Street 1:875 KINGS HWY STE 100
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3165
Practice Address - Country:US
Practice Address - Phone:856-251-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00365500163WP0809X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult