Provider Demographics
NPI:1639562515
Name:EWEN, DOROTHY A (NP-C)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:A
Last Name:EWEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12880 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-4909
Mailing Address - Country:US
Mailing Address - Phone:225-774-7111
Mailing Address - Fax:225-774-7714
Practice Address - Street 1:12880 PLANK RD
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-4909
Practice Address - Country:US
Practice Address - Phone:225-774-7111
Practice Address - Fax:225-774-7714
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAF0115899363LF0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine