Provider Demographics
NPI:1275098204
Name:EWERTZ, LAUREN SHELBY (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:SHELBY
Last Name:EWERTZ
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:SHELBY
Other - Last Name:PISTOTNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3450 N ROCK RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1327
Mailing Address - Country:US
Mailing Address - Phone:316-312-0002
Mailing Address - Fax:
Practice Address - Street 1:3450 N ROCK RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226
Practice Address - Country:US
Practice Address - Phone:316-312-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78530-112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily