Provider Demographics
NPI:1821168444
Name:MC EWEN, LILA MAE (NP)
Entity Type:Individual
Prefix:
First Name:LILA
Middle Name:MAE
Last Name:MC EWEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9808 CHATHAM CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8656
Mailing Address - Country:US
Mailing Address - Phone:907-622-1943
Mailing Address - Fax:
Practice Address - Street 1:11432 BUSINESS BLVD
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7720
Practice Address - Country:US
Practice Address - Phone:907-694-1300
Practice Address - Fax:907-694-1315
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP42800Medicare UPIN