Provider Demographics
NPI:1649398207
Name:EWIG, JOAN V (RD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:V
Last Name:EWIG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13111 N PORT WASHINGTON RD
Mailing Address - Street 2:COLUMBIA-ST. MARY'S
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-2416
Mailing Address - Country:US
Mailing Address - Phone:262-243-7564
Mailing Address - Fax:262-243-7318
Practice Address - Street 1:13111 N PORT WASHINGTON RD
Practice Address - Street 2:COLUMBIA-ST. MARY'S
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2416
Practice Address - Country:US
Practice Address - Phone:262-243-7564
Practice Address - Fax:262-243-7318
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered