Provider Demographics
NPI:1538117650
Name:EWART, JOLIE (ARNP)
Entity Type:Individual
Prefix:
First Name:JOLIE
Middle Name:
Last Name:EWART
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 E HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1257
Mailing Address - Country:US
Mailing Address - Phone:509-444-6367
Mailing Address - Fax:509-444-6371
Practice Address - Street 1:757 E HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1257
Practice Address - Country:US
Practice Address - Phone:509-444-6367
Practice Address - Fax:509-444-6371
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004827363LC1500X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9623240Medicaid
WA9623240Medicaid
WAAB11720Medicare ID - Type Unspecified