1003999137 NPI number — MRS. LOIS ELAINE LEWIS RN NURSE PRACTITIONE

Table of content: MRS. LOIS ELAINE LEWIS RN NURSE PRACTITIONE (NPI 1003999137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003999137 NPI number — MRS. LOIS ELAINE LEWIS RN NURSE PRACTITIONE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
LOIS
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN NURSE PRACTITIONE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEWIS
Provider Other First Name:
KATE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN NURSE PRACTITIONE
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1003999137
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2617 SURREY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MODESTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-529-1556
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 W GRANGER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MODESTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-579-9930
Provider Business Practice Location Address Fax Number:
209-579-9941
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  5066 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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