Healthcare Provider Details

I. General information

NPI: 1891243002
Provider Name (Legal Business Name): ALLISON GAIL EWING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 2ND ST
RICHLAND CENTER WI
53581-1900
US

IV. Provider business mailing address

455 LEONA AVE
RICHLAND CENTER WI
53581-2024
US

V. Phone/Fax

Practice location:
  • Phone: 608-647-6161
  • Fax:
Mailing address:
  • Phone: 608-604-8389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7237-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: