Provider Demographics
NPI:1043733041
Name:LEWIS, CAMERON NICHOLE (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CAMERON
Middle Name:NICHOLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 S FOUR MILE RUN DR UNIT 203
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-3913
Mailing Address - Country:US
Mailing Address - Phone:502-592-9080
Mailing Address - Fax:
Practice Address - Street 1:5845 RICHMOND HWY STE 150
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303-1868
Practice Address - Country:US
Practice Address - Phone:703-333-6960
Practice Address - Fax:703-256-8294
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1023367363LA2100X
VA0024176020363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024176020OtherVA- NURSE PRACTITIONER LICENSE