Provider Demographics
NPI:1043328602
Name:LEWIS, BARBRA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BARBRA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 OLD MCCLOUD RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-2796
Mailing Address - Country:US
Mailing Address - Phone:530-926-5100
Mailing Address - Fax:530-926-1859
Practice Address - Street 1:101 OLD MCCLOUD RD
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2796
Practice Address - Country:US
Practice Address - Phone:530-926-5100
Practice Address - Fax:530-926-1859
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503773363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05698ZMedicare PIN