Provider Demographics
NPI:1083279905
Name:LEWIS, JADEVYONNA (CPM, LM)
Entity Type:Individual
Prefix:
First Name:JADEVYONNA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24978 KEATOR RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2240
Mailing Address - Country:US
Mailing Address - Phone:760-985-4377
Mailing Address - Fax:760-818-8126
Practice Address - Street 1:18031 US HIGHWAY 18 STE B
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2152
Practice Address - Country:US
Practice Address - Phone:760-985-4377
Practice Address - Fax:770-818-8126
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife