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General NPI Number Information
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NPI Number | 1467712414
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Entity Type | Organization
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Legal Business Name | EWN, INC
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Dates
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Enumeration Date | 05/24/2012
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 240 S 5TH AVE SUITE B
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City | ST CHARLES
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State | IL
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Zip | 60174-2905
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Country | US
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Telephone | 314-223-2993
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Fax |
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Provider Business Mailing Address
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Address Line | 40W615 STONEBRIAR LN
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City | ELGIN
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State | IL
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Zip | 60124-8162
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Country | US
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Telephone | 314-223-2993
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Fax |
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Authorized Official
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Title or Position | CHILD AND ADOLESCENT PSYCHIATRIST
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Name | DR. ERIC WARD NOLAN
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Credential | MD
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Telephone | 314-223-2993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 036-121-588
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License Number State | IL
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