Provider Demographics
NPI:1194004150
Name:LEWIS, DUSTIN JAMES (FNP)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JAMES
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 1:691 MARAGLIA ST STE C
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1029
Mailing Address - Country:US
Mailing Address - Phone:530-605-4680
Mailing Address - Fax:530-605-4680
Practice Address - Street 1:691 MARAGLIA ST STE C
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1029
Practice Address - Country:US
Practice Address - Phone:530-222-3287
Practice Address - Fax:530-222-8547
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP20860363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP20860OtherFNP LICENSE