Provider Demographics
NPI:1063840247
Name:LEWIS, JAMES EVAN (FNP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EVAN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 UNION AVE
Mailing Address - Street 2:MEDICAL DEPT
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6367
Mailing Address - Country:US
Mailing Address - Phone:707-421-7150
Mailing Address - Fax:
Practice Address - Street 1:530 UNION AVE
Practice Address - Street 2:MEDICAL DEPT
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6367
Practice Address - Country:US
Practice Address - Phone:707-421-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21835363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily