Provider Demographics
NPI:1467508341
Name:LEWIS, CHARLETTA LEA (ARNP)
Entity Type:Individual
Prefix:
First Name:CHARLETTA
Middle Name:LEA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14027 N FRIENDSHIP LN
Mailing Address - Street 2:
Mailing Address - City:NINE MILE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99026-8721
Mailing Address - Country:US
Mailing Address - Phone:509-290-2641
Mailing Address - Fax:
Practice Address - Street 1:1044 11TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2506
Practice Address - Country:US
Practice Address - Phone:360-353-9422
Practice Address - Fax:360-353-9526
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00129609163WP2201X
WAAP60737780363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care