Provider Demographics
NPI:1376639120
Name:LEWANDOWSKI, STACY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:LEWANDOWSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-3525
Mailing Address - Country:US
Mailing Address - Phone:402-228-3366
Mailing Address - Fax:402-228-3502
Practice Address - Street 1:805 W COURT ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-3525
Practice Address - Country:US
Practice Address - Phone:402-228-3366
Practice Address - Fax:402-228-3502
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE948363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEQ63895Medicare UPIN