Provider Demographics
NPI:1326339912
Name:LEWIS, TONYA RAE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:RAE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:28 COLORADO DR
Mailing Address - Street 2:
Mailing Address - City:HOUTZDALE
Mailing Address - State:PA
Mailing Address - Zip Code:16651-8550
Mailing Address - Country:US
Mailing Address - Phone:814-342-5678
Mailing Address - Fax:814-342-0168
Practice Address - Street 1:1633 PHILIPSBURG BIGLER HWY
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-8112
Practice Address - Country:US
Practice Address - Phone:814-342-5678
Practice Address - Fax:814-342-0168
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN250595L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse