Provider Demographics
NPI:1003584640
Name:LEWIS, WILLIAM NATHANIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:NATHANIEL
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 S 132ND ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2573
Mailing Address - Country:US
Mailing Address - Phone:907-952-9727
Mailing Address - Fax:402-614-4416
Practice Address - Street 1:1300 37TH ST STE 1
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1900
Practice Address - Country:US
Practice Address - Phone:402-614-4969
Practice Address - Fax:402-614-4416
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IA117882363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program