Provider Demographics
NPI:1235666900
Name:EWERTZ, AMANDA A (ARNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:EWERTZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:347 S LAURA AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-1518
Mailing Address - Country:US
Mailing Address - Phone:316-686-7117
Mailing Address - Fax:316-686-2679
Practice Address - Street 1:347 S LAURA AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-1518
Practice Address - Country:US
Practice Address - Phone:316-686-7117
Practice Address - Fax:316-686-2679
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-123501363L00000X
KS77678363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner