Provider Demographics
NPI:1114672219
Name:EWING, LAWANDA L (MSN, CRNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LAWANDA
Middle Name:L
Last Name:EWING
Suffix:
Gender:F
Credentials:MSN, CRNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W SARATOGA ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-1749
Mailing Address - Country:US
Mailing Address - Phone:443-303-9335
Mailing Address - Fax:410-735-5212
Practice Address - Street 1:1501 W SARATOGA ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-1749
Practice Address - Country:US
Practice Address - Phone:443-303-9335
Practice Address - Fax:410-735-5212
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR201937363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily