Provider Demographics
NPI:1437472016
Name:MC EWAN, LAURA L (RN, MSN,FNP-BC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:MC EWAN
Suffix:
Gender:F
Credentials:RN, MSN,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2302
Mailing Address - Country:US
Mailing Address - Phone:949-923-3277
Mailing Address - Fax:855-812-5865
Practice Address - Street 1:1198 PACIFIC COAST HWY
Practice Address - Street 2:SUITE I
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6251
Practice Address - Country:US
Practice Address - Phone:562-799-7071
Practice Address - Fax:562-594-5627
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP19528363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB204574Medicare PIN