Provider Demographics
NPI:1003999137
Name:LEWIS, LOIS ELAINE (RN NURSE PRACTITIONE)
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:ELAINE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN NURSE PRACTITIONE
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN NURSE PRACTITIONE
Mailing Address - Street 1:2617 SURREY AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355
Mailing Address - Country:US
Mailing Address - Phone:209-529-1556
Mailing Address - Fax:
Practice Address - Street 1:205 W GRANGER AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-579-9930
Practice Address - Fax:209-579-9941
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5066363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner